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IDEAL HEATING, INC.- 001219- 9/20/2010 CARMEL REDEVELOPMENT COMMISSION 001219 Ideal Heating, Inc. Check: 1219 1417 N Harding Street Date: 9/20/2010 Indianapolis, IN 46202 Vendor: IDEAL1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 7 379,100.97 379,100.97 0.00 0.00 379,100.97 Application 7 . 379,100.97 0.00 0.00 379,100.97 379,100.97 ... :•,. , . •. ,2 , • ■ I , . ■ . . a • THIS CHECK HAS A ':,'.-.'.,:.'.Y'/-: V -•k- ' .4'. ". • 'S•''' ''''' COLORED 'LO- HEYBAi'CK GROUNCVA"'.N o.pc,d.4T'p! m'..tLT..;..IPL .,. :.:9:,uRIT,7 ..AT77•=s!. 7.7 ,,7,.<.?,...],,,DETAILS fii!.. ( " Cd?rel;hedeielopnert Commission - ; .Main :A;f646;§ :,,,,,:,,,7•,,,•,::-•c ..„ ',. C,itkig0,-- , .,: , -,.';;;:-,:;:!.'. „: ,..,',...'...,!".;',..' ' :' ... ,'2i' .':',,, -.::=. ,f.::'.' :=2::-.':':',=?:..:- .':'-', .;:=',:',.':',.;. :::,-;.':: :''';::':'•/;."-=,,`: :' :'. ''' '..-'1:,::/.c. ' 4 ''.'..-',.; • cARmELda`r6ei;,'Ii■4sp .2". -.:.-.::'2'-:::'.;,-;.:'--:-',.:,'....,' ': ' ' ': :-4 ''.Y.'.'.:::::::,::.-:2:4,',T':,-,::'{':'..'. - : •,-;,-;;;.,-;•-....',,,-,:::.,::,.:..;:".:::-..::.:..., ,,,, ,,..;,,,'....., . : -.. , . TH.'.:1-..:',,;:,,7 ::,. ,,,,:, , ...:,n':., ;:`. .' , • .' , '.' ' ' :::. ";: , :,',.I..W •:,--, ''..:',.::=,:. . ''.,':-,., '. :::::: ''‘: :::: k, ' ' ., . = 1219 •,.:.,-.. ,.., ;.:.',.,2:'.''s,,,!".,.,..,:.;.,'.... :-..::.-..„,.;: - ; :',--„,,, ., , ,,,. , - ' . . :'-'':.: ': . ''')'; :':;. '',:::::' .:', :. ':',■!:'' '::.'':'.:,:.':' : '.::. : : ''.. .: '' .. ' : .' ':':: .1:':,:.'':' 'D'Ai. - f:,,. . .,: , :.,..::: : .: AMOUNT• 9/20/2010 . ********"379,100 97 - PAY. .. 'Ti-I''.ES:6M' OE'.'71-1AREE HUNDRED SEVENTY NINE THOUSAND ONE HuNpiRpoLL...A7s?aN9,-0 1:CENTS. .i.,,,, .,.,,,?:.:,.: ORDER „ . . ... :-,.;,,,. Ideal Heating,,Inci, ,- , ., -, ,-.:;.,,,: .- ,,...., ' , „EN,„ 1417 N;Hrditig-Sti:eet;4„2- ::;, ,-, :,'''' , : ::, . ,:' :.., : j')' ,, ,....-. .-.,,-, , ,-, , .:- ' 'AigiNpr, •!:. -- — . .._,.._.:_______ iii: i:1414 IN-'4.620 ::::: :.;''': ..*':.:'::-:-; ;:.;''':-:If:. ",e " !., .;, ,. -.:- .- - 7.- ---.- II'0 0 L 2 L90 1:0740 Lli 2 L 31: 00137E04 L L LH° CARMEL REDEVELOPMENT COMMISSION 001210 Ideal Heating, Inc. Check: 1210 1417 N Harding Street Date: 9/16/2010 Indianapolis, IN 46202 Vendor: IDEAL1 Prior Invoice P.O. Num. Vk Invoice Amt Balance Retention Discount Amt. Paid 1 79 26,997.15 26,997.15 2,699.72 0.00 24,297.43 App 1 corrected t 60 2 79 e, j 121,298.77 121,298.77 12,129.87 0.00 109,168.90 Application 2 7 S-o l 1 379,100.97 379,100.97 0.00 0.00 ' 379,100.97 Application 7 -of 527,396.89 527,396.89 14,829.59 0.00 512,567.30 • VONERIB THIS3CHECK HASTA?COLORED3BACKGROUNDTANDICONTAINS.MULTIPLE#SECURITiYiEEATURES ;SEMAEKIEORMETAILS EI �"D6% Carmel Redevelopment Commission 001210 / '. ti 30 West Main Street A REGIONS Suite 220 20-1421/740 CARM . 4:r EL ct' Carmel, IN 46032 U DATE A UN di 9/16/2110 ******* 12,56` t PAY THE SUM OF FIVE HUNDRED TWELVE THOUSAND Fly: HUNDRED IXTY S= IOL • -P 30 CENT TO THE ORDER OF Ideal Heating, Inc. 1417 N Harding Street e- gE,4,,m I 07, ndianapolis, IN 46202 � 000L2Lo"• 1:0740042L31: 0087504LLL0 REI Construction Billing Invoice ,Itit 1 . CONSTRUCTION, LLC' Date: 8/10/2010 Bid Budget/ Original Revised Total Paid Item Subcontractor Description of Work Contract Change Orders Contract Total June July to Date BID Package#1' ° . , ,. • 1 !MacDougall Pierce ;General Trades/Interior Finishes I 448,9551 0 1 448,955 I $ - I BID.Package#2 - '. . ' - . . '. „ . . . j 2 'Ideal IiVAC /Mechanical/Plumbing/Fire Suppression 1 189,4001 0 1 189,400 24,297.43 I 109,168.90 $ 133,466.33 BID Package#3 1 3 1Maxwell Electric (Electrical Systems I 191,2401 0 1 191,240 1 I $ - I BID Package#4 4 1 O'Production Lighting 0 0 0 1 I $ - BID Package#5 , I 5 1 0 Sound&Communications 0 0 0 1 I $ - I BID Package#6 ° " - ' I• BUILDING PROJECT TOTALS less retainage 829,595 829,595 I 24,297.431 109,168.901 133,466 12 IRetainage Withheld I I I I I 2,699.571 12,130.101 14,830 BUILDING PROJECT TOTALS 829,595 829,595 I 26,997.001 121,299.001 148,296 13 'Total REI Staff Reimbursable 1 58,844 1 I 58,844 1 1 1 0 14 'Total General Requirements 1 1 01 01 0.001 I I 0 15 'Total Fee 5% ' 1 44,422 I 0 1 44,422 1 1,349.851 6,064.951 7,414.80 .e.,-- to 16 (Contingency 1 I 0 ' 01 01 1 1 'Total Project Cost � 932,861 I 932,861 � 25,647.281 115,233.851 $ 140,881.13 PAID SEP 172010 .. ,r s TM JUL 17 2010 Document G702 - 1992 Application and Certificate for Payment By TO� t R: PROJECT: APPLICATION NO: 2 Distribution to: onstruction Services VOG-Black Box Theater Suite Pennsylvania st. 3rd Ave SW& City Center Dr. PERIOD TO: 7/31/2010 OWNER ❑ Carmel,IN 46032-4559 Carmel, IN 46032 CONTRACT FOR: HVAC ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 5/11/2010 CONTRACTOR ❑ Ideal Heating Inc. Pedcor Design, LLC PROJECT NOS: 100502/ / FIELD ❑ 1417 N. Harding St. 355 City Center Drive Indianapolis, IN 46202 Carmel, IN 46032 INVOICE NO: 3662 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet,AIA Document G703,is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 189 400.00 which previous Certificates for Payment were issued and payments received from the Owner, and 1.ORIGINAL CONTRACT SUM $ that . -re payment shown herein is now due. 2.Net change by Change Orders $ 0.00 CO,Tj.'C 0 . Ideal e ' Oc. / 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 189,400.00 By: (0 a Date: ��Jr// d 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 148,295.92 State of: IN �,o T. / 5.RETAINAGE: County of: Hendricks o Y POB� RlzGPN, r;, ROBERTS a. 10 %of Completed Work taoraxv H `fif ricks County p Subscribed and sworn to before (Column D+Eon G703) $ 14,829.59 me this day of *!WA". ent * My Commission Expires / ge l y ao/a 47ilko 5' ). 29, 2016 b. 0 %of Stored Material e (Column F on G703) $ 0.00 Notary Public: Regan Roberts My Commission expires: 9/29/2016 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 14,829.59 6.TOTAL EARNED LESS RETAINAGE $ 133,466.33 ARCHITECT'S CERTIFICATE FOR YMENT " (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 24,297.43 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE $ 109,168.90 AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED $ 1 01168: (10 67 933. (Line 3 less Line 6) $ 55,933.67 (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ItReitTECT7 Ot..')Lr Total changes approved in previous months by Owner $ 0.00 $ 0.00 By: `A, .r/A Date: S /1 I/I cc Total approved this Month $ 0.00 $ 0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 0.00 $ 0.00 named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 0.00 the Owner or Contractor under this Contract. 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 G702TM—1992.Copyright ©1953,1963,1965,1971, 1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this 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 Docui4enkAilgail The American Institute of Architects'legal counsel,copyright @aia.org. SEP 7 097 Lulu PAID 4/44o91-7 Document 6702 TM— 1992 Instructions Application and Certificate'for-Payment GENERAL INFORMATION Purpose and Related Documents AIA Document G702,Application and Certificate for Payment, is to be used in conjunction with AIA Document G703,Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702, but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. COMPLETING THE G702 FORM After the Contractor has completed AIA Document G703,Continuation Sheet, summary information should be transferred to AIA Document G702,Application and Certificate for Payment. The Contractor should sign G702, have it notarized, and submit it, together with G703, to the Architect. The Architect should review G702 and G703 and, if they are acceptable,complete the Architect's Certificate for Payment on G702. The Architect may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A201.The Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 and G703 should be forwarded to the Owner. MAKING PAYMENT The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA Document G702,Application and Certificate for Payment.The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. EXECUTION OF THE DOCUMENT Persons executing the document should indicate the capacity in which they are acting(i.e.,president, secretary, partner,etc.) and the authority under which they are executing the document. Where appropriate,a copy of the resolution authorizing the individual to act on behalf of the firm or entity should be attached. AIA Document G702TM—1992.Copyright©1953,1963,1965,1971, 1978,1983 and 1992 by The American Institute of Architects.All rights reserved. WARNING:This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this 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. ... . ...-. '3- Document G703TM - 1992 _ k4 Continuation Sheet Page 2 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 2 containing Contractor's sigried certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. 7/15/2010 Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO: 7/31/2010 ARCHITECT'S PROJECT NO: 100502 A B C D E F G _ H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS % TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (G_C) FINISH (NOT IN TO DATE RATE) (D+E) D OR E) (D+E+F) (C-G) • EQL Equipment Labor 5,500 0 4,675 0 4,675 85 825 468 EQ Equipment . 42,000 0 42,000 0 42,000 100 0 4,200 SML Sheet Metal Labor 52,400 2,620 34,060 0 36,680 70 15,720 3,668 SM Sheet Metal 28,679 24,377 3,728 0 28,105 98 574 2,811 RGDL Regs.,Grilles,Difs.& Fan' 6,500 0 0 • 0 0 0 6,500 0 Labor • RGD Regs.,Grilles,Difs.& Fans 13,500 0 13,500 0 : 13,500 100 0 , 1,350 SUB1 White • ' 16,000 0 12,000 0 12,000 75 4,000 1,200 .River-Hydonics/Plumb. SUB2 Simplex Grinnel-Controls 22,671 0 11,336 0 11,336 50 11,336 1,134 SUB3 Johnson Controls-Air Bal. 2,150 0 0 0 0 0 2,150 0 189,400 26,997 121,299 0 148,296 78 41,104 14,830 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 G703TM-1992.Copyright©1963, 1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be 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. ATA® TM /it_I Document G703 - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703,Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201,General Conditions of the Contract for Construction. Use of Current Documents.Prior to using any ALA Contract Document,users should consult www.aia.org or a local ALA component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The ALA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AiA software users should consult the End User License Agreement(EULA).To report copyright violations of ALA Contract Documents,e-mail The American institute of Architects'legal counsel,copyright@aia.org. aia.org. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A,B&C.These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of column C may be adjusted by Change Orders during the Project. Column D.Enter in this column the amount of completed Work covered by the previous application(columns D&E from the previous application).Values from column F(Materials Presently Stored)from the previous application should not be entered in this column. Column E.Enter here the value of Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F.Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period.) Column G.Enter here the total of columns D, E and F.Calculate the percentage completed by dividing column G by column C. Column H.Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown he/ow are for illustrative purposes only,and are not intended to reflect actual construction costs. A B C D H F G H I WORK COMPLETED MATERIALS TOIAL BALANCE PRESENTLY COMPLETED o, RETAINAGE ITE\I DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS STORED AND 51 ORED TO (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (NO rIN TO DATE (G-CI FINISH RATE) ID E) D OR El (D+E+FI IC-G) 1 MOBILIZATION 5,000 5000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS&MISC CONC. 5,000 0 0 0 0 0 5,000 6 PAVING,UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING,LOWER DRIVE 20,000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 105,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703T"'-1992.Copyright©1963, 1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale 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. . 'i C @gyp � T: APPLICATION FOR PAYMENT JUL 17 2010 8 < PARTIAL WAIVER OF LIEN , By r,' Contractor: G1 °L I m l ' . S Address: �Ri^- is/. ,d. 1 6 . o.' Project Name and Address: Vo& — 16141Cr/30X 7,ec Period to: 7/451/0 Job#: f0--lam:: The Undersigned has been contracted by REI Construction, LLC as a Contractor in connection with construction of the Project owned by Owner and located as indicated above. The Undersigned, for and in consideration of any and all amounts paid to the Undersigned up to and including the date of execution hereof and other good and valuable consideration, the receipt whereof is hereby acknowledged, waives and releases any and all liens, notices of liens or of character, against, on or relating to or connected with the above-described Project and improvements located thereon and related thereto, on account of labor or services, materials, equipment, tools, machinery or apparatus furnished or leased, or which may be furnished or leased by, or at the request of, the Undersigned for the Project. The Undersigned hereby warrants that the Project cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services, materials, equipment, tools, machinery or apparatus to, or at the request of, the Undersigned for use in the Project. This instrument, and the waiver, release and representations hereunder, are for the benefit of, and may be relied upon by, the Owner, its successors, assigns and mortgagees, the above-named General Contractor or Construction Manager, and any other person by or through whom payments have been made to the Undersigned. p The undersigned, for and in consideration of the total payments in the sum of $ /0% /6'6'90 the receipt of which is hereby acknowledged, does hereby waive, release remise and relinquish any and all right to claim any lien or liens for work done or materials furnished, or any kind or class of lien whatsoever for said building or premises or project —� Dated this 75 day of /7;e y o?D/G) J4 e4/ treatva, Company C'�� , /l � BY: w TITLE: (/ NAME: 70647(#67�vl , , STATE OF 4/0f/al./ c3 COUNTY OF Wavy ov) Subscribed and sworn to before me, a Notary Public in and for said County and State, this /5 day of /y ,-20 ac?/0 My commission expires My county residence is f7t7 cf4-,/c re pi OBERTS '. 97o?0/6 ; e ' Hendricks County . *! � My Commission Expires kn/AO C;�;. 25, 2016 Nota P. `✓A \ Printed 4,4, ,. + ` -i ■ TM . r Document G702 - 1992 JUN 2 2 2010 Application and Certificate for Payment y TO I PROpJEECT' APPLICATION N0::1._._' Ceont"P-C*4) Distribution to: I truction Services .: V�G-Black Box Theater 6/30/2010 11711 North_Pennsylvania St. PERIOD TO: OWNER ❑ Suite 200 3rd Ave SW& City Center Dr. ;,.• Carmel, IN 46632-4559 Carmel, IN 46032 .CONTRACT FOR: HVAC ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE:5/11/2010 CONTRACTOR ❑ Ideal Heating Inc. 1417 N. Harding St. PROJECT NOS: 100502/ / FIELD ❑ 'Indianapolis, IN 46202 INVOICE NO: 3617 OTHER ❑ . CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance , AIA Document made for Continuation Sheet,is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 189 400.00 which previous Certificates for Payment were issued and payments received from the Owner, and 1.ORIGINAL CONTRACT SUM $ that current payment shown herein is now due. 2.NET CHANGE BY CHANGE ORDERS $ 0.00 CONT•, IR: Ide.I .o ;ting Inc. 3.CONTRACT SUM TO DATE(Line 1.f 2).. $ 1$9,400.00 � i �y i(�► L �T�• Date: C,/A i//0• 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 26,997.15 State of: IN 5.RETAINAGE: County of: Hendricks ' a. 10 %of Completed Work 4 Ppeli REGAN A. ROBERTS P Subscribed and sworn before � - ^ Hendricks County (Columns^D+Eon G703) $ 2,699.72 me this oZ/ day of (�uh� oCOfO P. My Commission Expires b. �:::. %of Stored Material ' 14'Dno Sep. 29, 2016 (Column F on G703) $ 0.00 Notary Public:` Regan Roberts M 2,699 72 My commission expires: 9/29/2016 Total Retainage(Lines 5a+5b, or Total in Column I of G703) $ • 6.TOTAL EARNED LESS RETAINAGE $ 24,297.43 ARCHITECT'S CERTIFICATE R PAYMENT (Line 4 minus Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 0.00 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, • information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE $ 24,29/.43 AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE` AMOUNT CERTIFIED $ 24/217 La (Line 3 minus Line 6) $ 165,102.57 (Attach explanation if amount certified differs Aomthe amount applied. Initial all figures on this Application and on the Continuation S meet that are changed to conform with the amount certified.) CHANGE ORDER SUMMARY. ADDITIONS DEDUCTIONS AIRGWFECT:e4-""4'`^« .. Total changes approved in previous months by Owner $ 0.00 $ 0.00 By: Date: 2 ii /6 Total approved this:tmonth $ 0.00 $ 0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTAL $ 0.00 $ 0.00 named herein:.Issuance,payment and acceptance of payment are without prejudice to any rights of ,NET CHANGES by Change Order $ /'�1 f 0.00 the Owner or Contractor under this Contract. PAID f D SEP 1 7 2010 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 G702TM—1992.Copyright ©1953,1963,1965,1971, 1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law . and International Treaties.Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 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. l-W,/7 r • a 4 `II°11`== Document G702 - 1992 Instructions IA Application and Certificate for Payment GENERAL INFORMATION Purpose and Related Documents. ALA Document G702,Application and Certificate for Payment, is to be used in conjunction with AIA Document G703TM,Continuation Sheet.These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 Tm,General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects' legal counsel,copyright @aia.org. COMPLETING G702 After the Contractor has completed ALA Document G703,Continuation Sheet,summary information should be transferred to ALA Document G702,Application and Certificate for Payment. The Contractor should sign G702, have it notarized,and submit it,together with G703,to the Architect. The Architect should review G702 and G703 and, if they are acceptable,complete the Architect's Certificate for Payment on G702. The Architect may certify a different amount than that applied for,pursuant to Sections 9.5 and 9.6 of A201. The Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount certified - and attach an explanation. The completed G702 and G703 should be forwarded to the Owner. MAKING PAYMENT The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA Document G702,Application and Certificate for Payment. The completed,form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. EXECUTING THE DOCUMENT Persons executing the document should indicate the capacity in which they are acting(i.e., president,secretary, partner,etc.)and the authority under which they are executing.lthe document. Where appropriate,a copy of the resolution authorizing the individual to act on behalf of the'firm or`entity should be attached. 1. • • • C. AIA Document G702TM'—1992.Copyright©1953,1963,19651971,1978„1983,and 1992 by The American Institute of Architects.All rights reserved. WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA®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. Document G7O3TM — 1992 •. .. ;...‘„,,,,, ... $ALLV •Continuation Sheet Page 2 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: . 1 . containing Contractor's signed certification is attached. APPLICATION DATE: 6/21/2010 In tabulations below,amounts are stated to the nearest dollar. Use Column.!on Contracts where variable retainage for line items may apply. . PERIOD TO: 6/30/2010 • ARCHITECT'S PROJECT NO: 100502 A B C D E F ' G H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS % TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G_C) FINISH RATE) (D+E) D OR E) (D+E+F) (C-G) EQL Equipment Labor 5,500 0 0 0 0 0 5,500 0 EQ Equipment 42,000 0 0 0 0 0 42,000 0 SML Sheet Metal Labor 52,400 0 2,620 0 2,620 5 49,780 262 SM Sheet Metal 28,679 0 24,377 0 24,377 85 4,302 2,438 RGDL Regs.,Grilles,Difs.& Fan 6,500 0 0 0 0 0 6,500 0 Labor . RGD Regs.,Grilles,Difs.& Fans 13,500 0 0 0 0 0 13,500 0 SUB1 White 16,000 0 0 0 0 0 16,000 0 River-Hydonics/Plumb. SUB2 Simplex Grinnel-Controls 22,671 0 0 0 0 0 22,671 0 SUB3 Johnson Controls-Air Bal. 2,150 0 0 0 0 0 2,150 0 • 189,400 0 26,997 0 26,997 14 162,403 2,700 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 G703TM—1992.Copyright©1963, 1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible 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. TM Document G703 - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner.Procedures for their use are covered in AIA Document A201,General Conditions of the Contract for Construction. Use of Current Documents.Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA.Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA).To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel, copyright @aia.org. COMPLETING THE G703 FORM Heading:This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum.The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed Work covered by the previous application(columns D&E from the previous application).Values from column F(Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period.) Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders:Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown below are for illustrative purposes only,and are not intended to reflect actual construction costs. A B C D f: E C H I WORK COMPLETED \IA'I'ERI.\IS 'I OTAI, BALANCE: PRESENTLY COMPLErE:D RETA I\'AGE ITEM SCHEDULED FROM PREVIOUS 10 (IF VARIABLE DESCRIPTION OF WORK STORED AND STORED NO VALUE APPLICATION 'THIS PERIOD INOT IN TO D.\T1. IG-C) EI\ISH RATE) ID+E) I)OR I:1 ID+E+F) IC-C') 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS S MISC.CONC. 5,000 0 0 0 0 0 5,000 6 PAVING,UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING,LOWER DRIVE 20,000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 105,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703TM-1992.Copyright©1963,1965, 1966,1967, 1970, 1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this 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 dounsel.copyright @aia.org. L i 7 4-/- APPLICATION FOR PAYMENT SUN d 2 PARTIAL WAIVER OF LIEN l4 2010 By Contractor: o I --Ti Gl H; .. Address: r Ar att^- iti- St, Project Name and Address: VOCS — 131aor t3oX 77e74'- Period to: C a/ O Job#: The Undersigned has been contracted by REI Construction, LLC as a Contractor in connection with construction of the Project owned by Owner and located as indicated above. The Undersigned, for and in consideration of any and all amounts paid to the Undersigned up to and including the date of execution hereof and other good and valuable consideration, the receipt whereof is hereby acknowledged, waives and releases any and all liens, notices of liens or of character, against, on or relating to or connected with the above-described Project and improvements located thereon and related thereto, on account of labor or services, materials, equipment, tools, machinery or apparatus furnished or leased, or which may be furnished or leased by, or at the request of, the Undersigned for the Project. The Undersigned hereby warrants that the Project cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services, materials, equipment, tools, machinery or apparatus to, or at the request of, the Undersigned for use in the Project. This instrument, and the waiver, release and representations hereunder, are for the benefit of, and may be relied upon by, the Owner, its successors, assigns and mortgagees, the above-named General Contractor or Construction Manager, and any other person by or through whom payments have been made to the Undersigned. �1C��7 The undersigned, for and in consideration of the total payments in the sum of $ L(1 0, 1 i—t the receipt of which is hereby acknowledged, does hereby waive, release remise and relinquish any and all right to claim any lien or liens for work done or materials furnished, or any kind or class of lien whatsoever for said building or premises or project Dated this ( day of 7e4h e cZo i1 C) eQ/ HTec nvia, . Company Na , l BY: 'A'/��/L- TITLE: (l ,P, NAME: 7:;-,vid 6A iti REC"s`' ,'. ROBERTS� t�enrIneks County STATE OF lh�I Q 9 * My Commission Expires COUNTY OF 'N111ko S'.':l 29 2016 /tea d'fo✓1 •ri$ "" / 51" Subscribed and sworn to before me, a Notary Public in and for said County and State, this 1 day of gCle/!C , 2689O/ 0 My commission expires /a9(, , , My county residence is �er/ledr�'l Notary Printed /r440 4-684;115 , .,&(5....,____ ��A r ' ' 1 17 2010 °e® '" �k` Document G702�M ® 1992 By -Application and Certificate for Payment TO��I R: PROJECT: APPLICATION NO: 7 Distribution to: onstruction.services Villiage on the Green Off.BIdg 11711 North Pennsylvania St. PERIOD TO: 7/31/2010 OWNER ❑ Suite 200 : 3rd Ave. SW& City Center Dr. Carmel,IN 46032-4559 Carmel, IN 46xxx CONTRACT FOR: HVAC ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: Ideal Heating Inc. Pedcor Design Group CONTRACT DATE: 10/30/2009 CONTRACTOR ❑ 1417 N. Harding St. 355 City Center Drive PROJECT NOS: 091111/ / FIELD ❑ Indianapolis, IN 46202 Carmel, IN 46032 INVOICE NO: 3664 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet,ALA Document G703,is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 968 50000 which previous Certificates for Payment were issued and payments received from the Owner, and . 1.ORIGINAL CONTRACT SUM $ that current payment shown herein is now due.•2. Net change by Change Orders $ 7,604.00 CONT!±.CT00R: Ideal Heating Inc. 3.CONTRACT SUM TO DATE(Line I ±2) $ 976,104.00 By: 46) �A Date: ��J��3 4.TOTAL COMPLETED&STORED TO DATE(Column G On G703) $ 890,400.00 State of: IN t jJ 5.RETAINAGE: County of: Hendricks � 5: .,. .:. .. 10 �`gPe RIr'� .n; �t. KOBERTS E.: a. %of Work i' o Subscribed and sworn to before � (Column_D+Eon G703) a NOT .1"° Henri iel'S County 0 $ 89,040.00 me this /5 day of vT4/y,. d/0 • * s i My, pi b. %of Stored Material �tatAt�� My Expires (Column F on G703) $ 0.00 Notary Public: Regan Roberts ���•` 't' 2016 89,040.00 My Commission expires: 9/29/2016 . ./�z='=sue' ` Total Retainage(Lines 5a+Sb or Total in Column I of 0703) $ -rf 6.TOTAL EARNED LESS RETAINAGE $ 801,360.00 ARCHITECT'S CERTIFICATE FOMENT ' (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 422,259.03 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to t ment of the 8.CURRENT PAYMENT DUE $ 379,100.97 AMOUNT CERTIFIED. p y 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED .. . $ 37?/05/�- 174 744.00 (Line 3 less Line 6) $ (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) CHANGE ORDER SUMMARY.. ADDITIONS DEDUCTIONS -ARCHITEC 6L--"J"N' • 5 854.00 0.00 1.//1/// 0 Total changes approved in previous months by Owner $ Date: Total approved this Month $ 1,750.00 $ 0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 7,604.00 $ 0.00 named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 1,604.00 the Owner or Contactor under this Contract. 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 G702TM—1992.Copyright ©1953,1963,1965,1971,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 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. P A I D SEP 1 1 /p /�o, 2�9� �(c{�o 9rz c fP/ Ai ik .. TM .\-7/ i iti® Document ® ;703 , ._".* ',-,..Continuation Sheet . Page 2 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 7 containing Contractor's•signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. 7/15/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 7/31/2010 ARCHITECT'S PROJECT NO: 091111 . A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK % TO PRESENTLY COMPLETED BALANCE RETAINAGE SCHEDULED FROM PREVIOUS NO. VALUE APPLICATION THIS PERIOD STORED AND STORED (G-C) FINISH (IF VARIABLE (D+E) (NOT IN TO DATE RATE) D OR E) (D+E+F) (C-G) CO1 Add-Chg Chilled & Hot Wtr 5,854 5,854 0 0 5,854 100 0 585 CO2 Add - Roof Hydrant 1,750 0 1,750 0 1,750 100 0 175 EQL Equipment Labor 14,000 1,400 10,500 0 11,900 85 2,100 1,190 EQ Equipment Material 245,870 61,468 184,403 0 245,870 100 0 24,587 SML Sheet Metal Labor 71,000 53,250 10,650 0 63,900 90 7,100 6,390 SM Sheet Metal Material 62,000 55,800 6,200 0 62,000 100 0 6,200 RGDL Regs., Grlls, Fans Labor 12,000 0 10,200 0 10,200 85 1,800 1,020 RGD Regs., Grilles, Fans Mat. 16,026 3,205 12,821 0 16,026 100 0 1,603 SUB1 Hydronic Piping 344,000 258,000 68,800 0 326,800 95 17,200 32,680 SUB2 Temperature Controls 147,000 14,700 102,900 0 117,600 80 29,400 11,760 SUB3 Air Balancing 13,104 0 0 0 0 0 13,104 0 SUB4 Crane/Lifts 13,000 0 13,000 0 13,000 100 0 1,300 -MP Temp Heat • 15,000 0 0 • 0 0 0 15,000 0 ACD AutoCAD Drawings 2,000 2,000 0 0 2,000 100 0 200 PER Permits/Bonding 13,500 13,500 0 0 13,500 100 0 1,350 976,104 469,177 421,223 0 890,400 91 85,704 89,040 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 G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this 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. APPLICATION O PAYMENT �I -? � c �I ��(a`7 PARTIAL WAIVER OF LIEN i Contractor: c c I eccli vi w [Ii JUL 17 2010 1, l' Address: / al vdV - .fi • By Villi i- 4 .4r A' C1�C9of r Project Name and Address: Ui l/GS(/yj//J,JC O',ThV e ire.--C\\G')(U1"��Cc'+UCe/Pf/ve . -prof& I'e: SW av)Period to: 7/3///2o/O Job #: 09-l a3 The Undersigned has been contracted by REI Construction, LLC as a Contractor in connection with construction of the Project owned by Owner and located as indicated above. The Undersigned, for and in consideration of any and all amounts paid to the Undersigned.up to and including the date of execution hereof and other good and valuable consideration, the receipt whereof is hereby acknowledged, waives and releases any and all liens, notices of liens or of character, against, on or relating to or connected with the above-described Project and improvements located thereon and related thereto, on account of labor or services, materials, equipment, tools, machinery or apparatus furnished or leased, or which may be furnished or leased by, or at the request of, the Undersigned for the Project. The Undersigned hereby warrants that the Project cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services, materials, equipment, tools, machinery or apparatus to, or at the request of, the Undersigned for use in the Project. This instrument, and the waiver, release and representations hereunder, are for the benefit of, and may be relied upon by, the Owner, its successors, assigns and mortgagees, the above-named General Contractor or Construction Manager, and any other person by or through whom payments have been made to the Undersigned. p The undersigned, for and in consideration of the total payments in the sum of $ -3 7 /i /Co the receipt of which is hereby acknowledged, does hereby waive, release remise and relinquish any and all right to claim any lien or liens for work done or materials furnished, or any kind or class of lien whatsoever for said building or premises or project � Dated this /S -ti day of GI((, '(2 0/0 60C%