The URL can be used to link to this page

Home My WebLink AboutHAGERMAN CONSTRUCTION CORP- 002956- 6/21/2012 CARMEL REDEVELOPMENT COMMISSION 002956 Hagerman Construction Corp Check: 2956 10315 Allisonville Road Date: 6/21/2012 Fishers, IN 46038-2016 Vendor: HAGEERM1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paic 28 29 23,768.00 23,768.00 0.00 0.00 23,768.0( 23,768.00 23,768.00 0.00 0.00 23,768.0( THE;KEYTOi,DOCUMENT SECURITY HEAT'ACTIVATED THUMB`PRINTr'ADDITIONAL SECURITY'FEATURES INCLUDED•:SEE BACK FOR DETAILS i;i"°fs% Carmel Redevelopment Commission 002956 1 / Alt- 30 West Main Street A REGIONS Suite 220 20-1421/740 o`" t Carmel, IN 46032 �sra►c 2956 DATE AMOUNT 6/21/2012 **********23,768.00 PAY THE SUM OF TWENTY THREE THOUSAND SEVEN HUNDRED SIXTY EIGHT DOLLARS AND NO CENTS*********** TO THE ORDER OF Hagerman Construction Corp 10315 Allisonville Road SENg Fishers, IN 46038-2016 ,A> r° 11'00 295611' 1:0740 L4 2 131: 008 7 SO4 11 L0 e � 1 .—, oc ment G7321M ® 2009 �-`� �� "!..?"4 -o �I Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: PROJECT: pal 7A, Regional Performing Arts APPLICATION NO:28 DISTRIBUTION TO: Carmel Redevelopment Commission Gaiter Invoice #84081 OWNER _ City of Carmel PERIOD TO:10/31/11 CONSTRUCTION MANAGER mil, IN 46032 VIA CONSTRUCTION CONTRACT DATE: ARCHITECT CONTRACTOR: MANAGER:Shiel Sexton PROJECT NOS:2695 / / CONTRACTOR _ Hagerman Construction Corporation FIELD HCC Job #2613 CONTRACT FOR: VIA ARCHITECT: CSO Architects OTHER CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous AIA Document G703TM,Continuation Sheet,is attached. Certificates for Payment were issued and payments received from the Owner,and that current payment 1.ORIGINAL CONTRACT SUM $ 5,588,000.CO shown herein is now due. 2.NET CHANGES IN THE WORK $ 417,439.00 CONTRACTOR:Hagerman Construction Corporation 3.CONTRACT SUM TO DATE(Line I±2) S 6,005,439.00 By: Q�`Fl ..1,1.../..4-e- 4,.I�,;L.�,t Date: October 18, 2011 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) $ 5,992,661.00 State of: Indiana �.�v"..vegu�� 5.RETAINAGE: County of: Allen „Ww"` f,\/ID C T t a. %of Completed Work Subscribed and sworn to before ,. ' ••.., 3 I (Column D+Eon 0703) $ 299,083.55 me this 18 ay oiOC obe 11 $O T,9 ..� tee e r- S '.. b. %of Stored Material Notary Pu - -L :(!�f. (Column F on G703) $ My Commission expires: 12/16/15 Cr �� Total Retainage(Lines 5a+5b,or Total in Column Ion G703) S 299,083.55 CERTIFICATE FOR PAYMENT - Ge(I C 6.TOTAL EARNED LESS RETAINAGE $ 5,693,511.45 In accordance with the Contract Documents,based on evaluation kj ,='Work and tbe'dat.omprising this application,the Construction Manager and Architect certify to i'a►r,. ..•.,to .4....fist of their (Line 4 minus Line 5 Total) PP g fY �� ,,,,,. 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT 5,669,809.45 lcnowledge,information and belief the Work has progressed as indicated, 4:•=xrc_.*:?• the Work is in (Line 6 f om prior Certificate) accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT 8.CURRENT PAYMENT DUE $ 23,768.cd CERTIFIED. a D 0 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED $ 2� 11 to S. (Attach explanation if amount certified differs from the amount applied..Initial all figures on this (Line 3 minus Line 6) $ 311,861.55 Application and on the Continuation Sheet that are changed to conform with,the amount certified.) CONST UCT_ By: Date. 5.*/S` Z SUMMARY OF CHANGES IN THE WORK ADDITIONS _ DEDUCTIONS ARCHITECT:(NOTE:If Multiple Prime Contractors are responsible for peforniating portions of the Total changes approved in previous months by Owner $ 421,646.00 S 27,975.00 Project, !r 1.',1 t ' Certification is not required.) Total approved this month,including Construction Change By: r1 Date: • i & • 1,01 Z Directives $ 23,768.00 S n no This Certificate is w negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named TOTALS $ 445,414.00 $ 27,975.00 herein.Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner NET CHANGES IN THE WORK $ 417,439.00 or Contractor under this Contract. CAUTION:Ycu 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 G7321M—2009(formerly G702T"CMa—1992).Copyright©1992 and 2009 by The American Institute of Architects.All rights reserved.WARNING:This AIA'Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be 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. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 1 OFS PAGES AIA Document G702,APPLICATION AND CER I IYICATE FOR PAYMENT, APPLICATION NO.: 00028 containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 10/31/11 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C 1) E F G H I . WORK COMPLETED MATERIALS TOTAL BALANCE RETAINACE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % TO NO VALUE STORED AND STORED - FINISH tIF VARIABLE} APPLICATION THIS PERIOD (NOT IN TO DATE (G' RATE (D+E) D OR E) (D+E+F) (C-G) 0000010 GENERAL CONDITIONS 0000020 Bond $41,375.00 $41,375.00 $0.00 $0.00 $41,375.00 100.000 $0.00 $0.00 0000030 General Conditions $169,586.00 $169,586.00 $0.00 $0.00 $169,586.00 100.000 $0.00 $0.00 0000040 Supervision/Engineering $320,164.00 $320,164.00 $0.00 $0.00 $320,164.00 100.000 $0.00 $0.00 0000045 Equipment/Operators $383,328.00 $383,328.00 $0.00 $0.00 $383,328.00 100.000 ' $0.00 $0.00 0000050 Owner Allowance . $55,000.00 $42,222.00 $0.00 $0.00 $42,222.00 76.767 $12,778.00 $0.00 0000055 Subtotal General Conditions $969,453.00 $956,675.00 $0.00 . $0.00 $956,675.00 98.682 $12,778.00 $0.00 0000060 EARTHWORK 0000070 Excavation/Backfill $795,000.00 $795,000.00 $0.00 $0.00 $795,000.00 100.000 $0.00 $0.00 0000080 SIIe Utilities $200,000.00 $200,000.00 $0.00 $0.00 $200,000.00 100.000 $0.00 $0.00 0000090 Soil Treatment(Termiticide) $6,448.00 $6,448.00 $0.00 $0.00 $6,448.00 100.000 $0.00 $0.00 0000095 Subtotal Earthwork $1,001,448.00 $1,001,448.00 $0.00 $0.00 $1,001,448.00 100.000 $0.00 $0.00 0000110 CONCRETE 0000120 Footings Labor $206,046.00 $206,046.00 $0.00 $0.00 $206,046.00 100.000 $0.00 $0.00 0000130 Footings Material $202,588.00 $202,588.00 $0.00 $0.00 $202.588.00 100.000 $0.00 $0.00 0000140 Foundation Walls/Piers Labor $603,561.00 $603,561.00 $0.00 $0.00 $603,561.00 100.000 $0.00 $0.00 0000150 Foundation Walls/Piers Material $414,224.00 $414,224.00 $0.00 $0.00 $414,224.00 100.000 $0.00 $0.00 0000160 Slabs on Grade Labor $47,650.00 $47,650.00 $0.00 $0.00 $47,650.00 100.000 $0.00 $0.00 0000170 Slabs on Grade Material $91,157.00 $91,157.00 $0.00 $0.00 $91,157.00 100.000 $0.00 $0.00 0000180 Elevated Slabs Labor $29,485.00 $29,485.00 $0.00 $0.00 $29,485.00 100.000 $0.00 . $0.00 0000190 Elevated Slabs Material $24,740.00 $24,740.00 $0.00 $0.00 $24,740.00 100.000 $0.00 $0.00 0000200 Elevator Shafts Labor $167,945.00 $167,945.00 $0.00 $0.00 $167,945.00 100.000 $0.00 $0.00 0000210 Elevator Shafts Material $61,125.00 $61,125.00 $0.00 $0.00 $61,125.00 100.000 $0.00 $0.00 0000220 Columns Labor $134,436.00 $134,436.00 $0.00 $0.00 $134,436.00 100.000 $0.00 $0.00 0000230 Columns Material $51,221.00 $51,221.00 $0.00 $0.00 $51,221.00 100.000 $0.00 $0.00 0000240 Slabs on Metal Deck Labor $116,191.00 $116,191.00 $0.00 $0.00 $116,191.00 100.000 $0.00 $0.00 0000250 Slabs on Metal Deck Material $245,878.00 $245,878.00 $0.00 $0.00 $245,878.00 100.000 $0.00 $0.00 0000260 Topping Slab/Stair/Curb Labor $88,023.00 $88,023.00 $0.00 $0.00 $88,023.00 100.000 $0.00 $0.00 0000270 Topping Slab/Stair/Curb Material $61,026.00 $61,026.00 $0.00 $0.00 $61,026.00 100.000 $0.00 $0.00 0000280 Rebar Labor $239,605.00 $239,605.00 $0.00 $0.00 $239,605.00 100.000 $0.00 $0.00 0000290 Rebar Material $406,775.00 $406,775.00 $0.00 $0.00 $406,775.00 100.000 $0.00 $0.00 0000300 Misc.Metals Labor $27,015.00 $27,015.00 $0.00 $0.00 $27,015.00 100.000 $0.00 $0.00 A1A DOCUMENT 6703•Al'Pi.1CATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AMA@•01992•THE AMERICAN INSTITUTE OF ARCHTIECTS,1735 NEW YORK 6703-1992 AVENUE,N.W.,WASHINGTON.D.C.200065292 •WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. -no doarne d bas bane ropmodumd ehearotdrlar with the pemehsbn ofTes Ammncn•fnsraeto of Amtdtee5 meet License 97003 to Pdmavern Systems.fro Ropm erAm. ,of pee document t,sd propel speoee ttdot:eadfat is not pomdaed Contact The AhdMC 1'rotete of Ar..MM_Zs to mita Ile c etero'teem ofiMs document and license status• CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 5 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00028 • containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:10/31/11 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A 13 C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED RETAINAGE NO. DLSCR1PI70N OF WORK VALUE FROM PREVIOUS STORED AND STORED �� FLNISH ([F VARIABLE) APPLICATION THIS PERIOD RATE (NOT IN TO DATE (G=C) (C-G) (D+E) D OR E) (D+E+F) 0000310 Misc.Metals Material $38,003.00 $38,003.00 $0.00 $0.00 $38,003.00 100.000 $0.00 $0.00 0000315 Subtotal Concrete $3,256,694.00 $3,256,694.00 $0.00 $0.00 $3,256,694.00 100.000 $0.00 $0.00 0000330 THERMAL AND MOISTURE PROTECTION 0000340 Insulation Labor $3,877.00 $3,877.00 $0.00 $0.00 $3,877.00 100.000 $0.00 $0.00 0000350 Insulation Material $15,268.00 $15,268.00 $0.00 $0.00 $15,268.00 100.000 $0.00 $0.00 ' 0000360 Waterproofing Labor $90,000.00 $90,000.00 $0.00 $0.00 $90,000.00 100.000 $0.00 $0.00 0000370 Waterproofing Material $122,960.00 $122,960.00 $0.00 $0.00 $122.960.00 100.000 $0.00 $0.00 0000380 Caulking Labor $13,300.00 $13,300.00 $0.00 $0.00 $13,300.00 100.000 $0.00 $0.00 0000390 Caulking Material $16,600.00 $16,600.00 $0.00 $0.00 $16,600.00 100.000 $0.00 $0.00 0000400 Subtotal Thermal&Moisture Protection $262,005.00 $262,005.00 $0.00 $0.00 $262,005.00 100.000 $0.00 $0.00 0000420 SPECIAL CONSTRUCTION 0000430 Vibrafion Sound Control-Jack Up Floor Systel $98,400.00 $98,400.00 $0.00 $0.00 $98,400.00 100.000 $0.00 $0.00 0000450 CHANGE ORDER#01 0000460 Alternate Parking ($20,000.00) ($20,000.00) $0.00 $0.00 ($20,000.00) 100.000 $0.00 $0.00 0000480 CHANGE ORDER#02 0000490 Oculus Alternate $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000510 CHANGE ORDER#03 0000520 PC 10R2-Elevator Changes $27,828.00 $27,828.00 $0.00 $0.00 $27,828.00 100.000 $0.00 $0.00 0000540 CHANGE ORDER#04 0000550 PC 10R2-Elevator Changes $11,926.00 $11,926.00 $0.00 $0.00 $11,926.00 100.000 $0.00 $0.00 0000570 CHANGE ORDER#05 0000580 PC 18-Sanitary Sewer Force Main Piping $9,707:00 $9,707.00 $0.00 $0.00 $9,707.00 100.000 $0.00 $0.00 • 0000600 CHANGE ORDER#06 0000610 PC O5R1-ASI#2 Speaker Boxes $26,221.00 $26,221.00 $0.00 $0.00 $26,221.00 100.000 $0.00 $0.00 0000630 CHANGE ORDER#07 AMA DOCUMENT G703.APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION •AAA*•01992•THE AMERICAN NsmvrE OF ARCHITECTS,1735 NEW YORK G703-1992 AVENUII,N.W.,WASrTNGTON,D.C.200n6-5292 •WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'rb's docunee3 Muss Remy m'tuoduaed oretinmkm yelT the pe,ml,,, n eriMe AmotbYn hrstbutw of Atrela ds u.rdc+Uvsrse e7073 to Pdmavem systems.be Remlutron of e is doateout%Moot prolen specme tMdmaeon R not ponMrod CxWJThe fleet,,,t eeniea of Ambled: to Var7v the ees d seoten of this doamenr end!Ammo dstoo.' CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3 OF 5 PAGES • AIA Document 0702,APPLICATION AND CERi"lt•1CATE FOR PAYMENT, APPLICATION NO.: 00028 containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:10/31/11 Use Column I on Contracts where variable rota inage for line items may apply. ARCHITECTS PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESLNTLY COMPLETED % TO Rb7 A IAB E NO. VALUE STORED AND STORED FINISH (IF VARIABLE) APPLICATION THIS PERIOD RATE (NOT IN TO DATE (L'T''-� (C-G) (D+E) D OR E) (Dm-£+F) 0000649 PC 12R1-Foundation Changes $5,744.00 $5,744.00 $0.00 $0.00 $5,744.00 100.000 $0.00 $0.00 0000660 CHANGE ORDER#08 0000670 PC#15R1-Reduce Size of HDPE Pipe ($1,175.00) ($1,175.00) $0.00 $0.00 ($1,175.00) 100.000 $0.00 $0.00 0000690 CHANGE ORDER#09 0000700 PC 22-HDPE Single Wall Pipe $554.00 $554.00 $0.00 $0.00 $554.00 100.000 $0.00 $0.00 0000720 CHANGE ORDER#10 0000730 PC 23-Change Drainage Layer Stone $14,139.00 $14,139.00 $0.00 $0.00 $14,139.00 100.000 $0.00 $0.00 0000750 CHANGE ORDER#11 0000760 PC 04R2-ASI#1 Modification to Utility Tunne $1,757.00 $1,757.00 $0.00 $0.00 51,757.00 100.000 50.00 $0.00 0000780 , CHANGE ORDER#12 0000790 PC 06R2-ASI#3 Added Columns $12,142.00 $12,142.00 $0.00 $0.00 $12,142.00 100.000 $0.00 $0.00 0000810 CHANGE ORDER#13 0000820 PC 09R2-ASI#6 Various Changes $22,449.00 $22,449.00 $0.00 $0.00 $22,449.00 100.000 $0.00 $0.00 0000840 CHANGE ORDER#14 0000850 PC 0982-ASI#6 Various Changes $32,257.00 $32,257.00 $0.00 $0.00 $32,257.00 100.000 $0.00 $0.00 0000870 CHANGE ORDER#15 0000880 PC 02R1-Added&Extended Piers $6,578.00 $6,578.00 $0.00 $0.00 $6,578.00 100.000 $0.00 $0.00 0000900 CHANGE ORDER#16 0000910 PC 35-Water Main Sleeve $1,757.00 $1,757.00 $0.00 $0.00 $1,757.00 100.000 $0.00 $0.00 0000930 CHANGE ORDER#17 0000940 PC 0SR1-Speaker Boxes-West $29,820.00 $29,820.00 $0.00 $0.00 $29,820.00 100.000 $0.00 $0.00 0000960 CHANGE ORDER#18 0000970 PC 34R2-ASI#40 Sanitary Force Main . $18,987.00 $18,987.00 $0.00 $0.00 $18,987.00 100.000 $0.00 $0.00 AIA DOCUMENT GT03•APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIM.:-01992 •THE AMEIUCAN INS 1 i 1 UTE OF ARCHITECTS,1735 NEW YORK G703-1992 AVENUE,N.W,WASHINGTON,D.C. 2(1006-5292 •WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'Rds dacL,nert Ius berm raprod„ao oloehorernpv 51h the pmettle n env MWt000 Ins11u5 of Archoacls tinder lkcnso 970110 P,'mo,mo Systems.ht.Reproduction ores Coarmenl se snt prolwspedlk Infomoofon ts not pmmgted.Coned The ASedwre Menu%of Archlnei•. to welly fir=me vorsrm rf thhr do0umar.1 artticarso status.' • CONTINUATION SHEET ATA DOCUMENT G703 PAGE.1 OF 5 PAGES AIA Document G702,APPLICATION AND CER1 IiUICATE FOR PAYMENT, APPLICATION NO.: 00028 containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:10/31/ll Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 0826I 3A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLL-i lit.) , F VARIABLE) DESCRIPTION OF WORK FROM PREVIOUS �o TO (IF VARIABLE) STORED AND STORED FINISH NO. VALUE APPLICATION THIS PERIOD (NOT iN TO DATE (G=C) RATE (C-G) (D+E) D OR E) (DoE+F) 0000990 CHANGE ORDER#19 0001000 Credit for Commercial Stone In lieu of INDOT ($6,800.00) ($6,800.00) $0.00 $0.00 ($6,800.00) 100.000 $0.00 $0.00 0001020 CHANGE ORDER#20 0001030 PC 26-ASI#11 Added Curbs $5,428.00 $5,428.00 $0.00 $0.00 $5,428.00 100.000 $0.00 $0.00 0001050 CHANGE ORDER#21 0001060 PC 27R2-ASI 17 Utilitly Vault Modifications $8,505.00 $8,505.00 $0.00 $0.00 $8,505.00 100.000 $0.00 $0.00 0001080 CHANGE ORDER#22 0001090 PC 07-Unsuitable Soils at Tunnel $22,060.00 $22,060.00 $0.00 $0.00. $22,060.00 100.000 $0.00 $0.00 0001110 CHANGE ORDER#23 0001120 PC 03-Unsuitable Soils $9,520.00 $9,520.00 $0.00 $0.00 $9,520.00 100.000 $0.00 $0.00 0001140 CHANGE ORDER#24 0001150 PC 33-Unsuitable Soils $3,678.00 $3,678.00 $0.00 $0.00 $3,678.00 100.000 $0.00 $0.00 0001170 CHANGE ORDER#25 0001180 PC 37-Generator Slab $2,132.00 $2.132.00 $0.00 $0.00 $2,132.00 100.000 $0.00 $0.00 0001200 CHANGE ORDER#27 0001210 PC 31 Added Masonry Footing $3,751.00 $3,751.00 $0.00 $0.00 $3,751.00 100.000 $0.00 $0.00 0001230 CHANGE ORDER#28 0001240 PC 41R1 ASI#27 SOG Modifications $4,293.00 $4,293.00 $0.00 $0.00 $4,293.00 100.000 $0.00 $0.00 0001260 CHANGE ORDER#29 0001270 PC 28R1 ASI#18 Garbage Vacuum Pit $3,181.00 $3,181.00 $0.00 $0.00 $3,181.00 100.000 $0.00 $0.00 0001290 CHANGE ORDER#30 0001300 PC 29 ASI#21 South Entrance Stairs $7,870.00 $7,870.00 $0.00 $0.00 $7,870.00 100.000 $0.00 $0.00 AIA DOCUMENT 0703•Ap1'l.ICATION AND CERTIFICATE I'OR PAYMENT • 1992 L•DrnoN -Al A'S'•*1992 •THE AMERICAN n TflTE OF ARCHITECTS,1735 NEW YORK G703-1992 AV/UE,N.1..,R AstnNOToN,D.C.30006.5292 •WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. "Tits dxhmsnd hos botot otrooOLOOtti os! tono'o!^hB pean!saon omThe Mordxn hosftttdn MAhCMaeb uMer ttense 971103 to Ptto aemra Sye'ems.too Roprot!ottah otmts EocutootJ t'AIInla prcgn:t$pCW.e Ir1,....,r.,.,is not Potntited Cenaet Thh 5'nrlcm)L•dHate of ArthS,Ctc M•afro hn=not',errs:.of this donh.roro tentfitOttore senor.' • • ' CONTINUATION SHEET AlA,DOCUMENT G703 PAGESOF5PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00028 containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 10/3111 Use Column I on Contracts where variable retainage for line items may apply. ARCH.111;CT'S PROJECT NO.: 0826I3A A B C D B F G H I WORK COMPLETED MATERIALS TOTAL BALANCE 2TGWf PRESENTLY COMPLETED RETAFNAGE DESCRIPTION OF WORK SCHEDULED FROM PREV TOCfS % TO RE NO. VALUE STORED AND STORED FINISH VARIABLE) APPLICATION THIS PERIOD RATE (NOT IN TO DATE (�� (C-G) (D+E) D OR E) (D+E+F) 0001320 CHANGE ORDER#31 0001330 PC 30R1 ASI#22 Platform lift Pit $5,106.00 $5,106.00 $0.00 $0.00 $5,106.00 100.000 $0.00 $0.00 0001350 CHANGE ORDER#32 0001360 PC 36R4 Column Encasement East $27,521.00 $27,521.00 $0.00 $0.00 $27,521.00 100.000 $0.00 $0.00 0001380 CHANGE ORDER#33 0001390 PC 36R4 Column Encasement West $28,000.00 $28,000.00 $0.00 $0.00 $28,000.00 100.000 $0.00 $0.00 0001410 CHANGE ORDER#34 0001420 PC 43R1 Slab Openings $1,414.00 $1,414.00 $0.00 $0.00 $1,414.00 100.000 $0.00 $0.00 0001440 CHANGE ORDER#35 . 0001450 PC 45R1 Saw Cutting of Foundation Wall $1,419.00 $1,419.00 $0.00 $0.00 $1,419.00 100.000 $0.00 $0.00 0001470 _ CHANGE ORDER#37 0001480 PC 42R1-ASI#68 Columns Modifications .$2,671.00 $2,671.00 $0.00 $0.00 $2,671.00 100.000 $0.00 $0.00 0001500 CHANGE ORDER#38 0001510 PC 51 Chipping Gutter Wall to 4' $1,784.00 $1,784.00 $0.00 $0.00 $1,784.00 100.000 $0.00 $0.00 0001530 CHANGE ORDER#39 0001540 PC 49 Locate Water Main Valve $1,447.00 $1,447.00 $0.00 $0.00 $1,447.00 100.000 $0.00 $0.00 0001555 CHANGE ORDER#40 0001556 PC#55-RCP#6-Catering Kitchen $23.768.00 $0.00 $23,768.00 $0.00 $23.768.00 100.000 $0.00 $0.00 0001560 CHANGE ORDER#41 0001570 Structural Steel Delay Settlement $50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100.000 $0.00 $0.00 $6,005,439.00 $5,968,893.00 $23.768.00 $0.00 $5,992,661.00 99.79% $12,778.00 $0.00 AIA DOCUMENT 0703•APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDTFIOI4 •ATM,• 01992 •THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK G703-1992 AVENUE,N.N.,WASHINGTON,D.C.20006-5292 •WARNING: Unllcansed photocopying violates U.S_copyright laws and will subject the violator to legal prosecution. 'mts document Pm been tepeodocad Meeroscaavan%eo permenton of TLe&odrnr.Wade of ntdelee fo ureter License 97073 to Ptseve n System.fie.Reptedtnflen of this chrxtrentvetthtsd pevteoseeptIc LWormellon Is trot pe-ndltsd.Contact TNT Aenertan Ststtute of Ate'dtt ofs toverey the cunerd yeRt,n efthts document end kvtese status.' WAIVER OF LIEN . The undersigned's the duly authorized officerof • . 1,01:: .• • •.• - .• the generaicontractor, - ,• (Name of Company) subcontractor;materlalman or other person furnishing the Services, labor, material or•equipment indicated below Irt the construction of improvements upon real estate located in rrami!bon .County, State of •Indiana , commonly .. known as . Am- •- •mu. •• ; - 'which real estate isowned.bycarmpl Rpapvlopment . , .("Owner"). Center Commission•INCONSIDERATION ofthe sum of . -- _.. .-OS • • .. ..• e e e e DOLLARS($ 21,768.00 ),receipt of which is hereby acknowledged,and in order to procure one or more payments ' •for Services,labor, material or equipment provided in such construction,the Company does hereby waive,•release and quit• claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made,and their assigns,all liens or claim or right to liens upon the land or improvements above'described which the Company may now haveforservices,labor,material or equipmentfumished in respect of such land or improvements to and including the date hereof.Theundersi gnedwarrantsthattheCompanyhasnotandwillnotass ignanyplaimforpayment nor any right to perfect a lien against the real estate,and that he has the right to execute this waiver and release of liens on behalf of himself(herself)and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to ' the services, labor,material or equipment to the Owners or lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder Is the sole•consideration received by the Company for said services,labor,material or equipment furnished to date,and that the Company ha's neither received nor made any security interest,title retention interest or lien rights in the said services,labor,material or equipment other thanthat released and transferred hereby. • The iaterial,labor,services or equipment furnished ire more particularly described in the affidavit for payment submitted of even date herewith. The undersignedfurtherwarrantsandrepresentsthattheCompanyhascompiiedwithallprevailingwage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 18th day of ' October 2011 /nforr,v and Tifilal . I Theresa Lanning, Treasurer • • Hagerman Con etr»rt i nns orrorat i on ' (Name of company) State of -Indiana , County of Allen , i SS: Before me, the . undersigned,a Notary Public in and for said County and State,personally appeared_ Theresa_Lanninq , the treasurer , of _ .__.,,,_. __ ___ __ _ _ __ __ - •_` who acknowledged (Title) (Name of Company) ' the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such Company and the•free act and deed of said officer. . • WITNESS my hand arid notarial seal this 18th day of October • ,• 20i 1 . • My Commission Expires: Notary Public • 12/16/15 0, • My County of Residence: . .. ' David C. Thomas (Printed Name of Notary Public) I . Allen Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee H�9 Erman (on d-r al) ((la tn Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) .a-)\-\\ 1 K (VIA e 5 A c ori6Xr ■ Ark 23 - G S Total rin ° I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have at i ed same in accor- dance with IC 5-11-10-1.6. '� , 20 I2. - -Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 H&90h11\an (on5 i-KAM (orlfordiot IN SUM OF $ $ 1 6t uD ON ACCOUNT OF APPROPRIATION FOR NL/ \'\0 / Board Members D PT.ti INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), 'k'-1607 a� 237�$, or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 6-1Z- 2012 Exe 1Ngtirector Title Cost distribution ledger classification if Carmel Redevelopment Commission claim paid motor vehicle highway fund