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INDIANA STEEL FABRICATING, INC.- 193- 3/16/2011
Indiana Steel Fabricating, Inc Check: 193 4545 West Bradbury Ave Date: 3/16/2011 Indianapolis, IN 46241 Vendor: INDSTEEL Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 7 74,448.00 74,448.00 0.00 0.00 74,448.00 App 7 for theater 74,448.00 74,448.00 0.00 0.00 74,448.00 193 3/16/2011 **********74,448.00 THE SUM OF SEVENTY FOUR THOUSAND FOUR HUNDRED FORTY EIGHT DOLLARS AND NO CENTS*********** Indiana Steel Fabricating, Inc 4545 West Bradbury Ave Indianapolis, IN 46241 Indiana Steel Fabricating, Inc Check: 193 4545 West Bradbury Ave Date: 3/16/2011 Indianapolis, IN 46241 Vendor: INDSTEEL Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 7 74,448.00 74,448.00 0.00 0.00 74,448.00 App 7 for theater 74,448.00 74,448.00 0.00 0.00 74,448.00 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 1 PAGES( TO OWNER: Cannel Theater Development Corp.,LLC PROJECT: VOG-Parcel 7-C-1 Theater APPLICATION NC): S E V E N Distribution to: 11711 North Pennsylvania Street-Suite 200 3rd Avenue SW OWNER Carmel, Indiana 46032 Carmel, Indiana 46032 ARCHITECT PERIOD TO: 1/30/2011 CONTRACTOR FROM CONTRACTOR: Indiana Steel Fabricating, Inc. VIA ENGINEER: Pedcor Design Group,LLC 4545 West Bradbury Ave. 355 City Center Drive Indianapolis, Indiana 46241 Carmel, Indiana 46032 PROJECT NO: 12012 (317)247-4545 CONTRACT DATE: 4/14/2010 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 $ 1,378,300.00 2. Net change by Change Orders $ (10,480.00) CONT'�, •1' I('.DIANA STEEL FABRICATING,INC. 3. CONTRACT SUM TO DATE(Line 1±2) $ 1,367,820.00 4. TOTAL COMPLETED&STORED TO DATE $ 1,312,806.25 ►'i;� By: �� `' Date: January 17,2011 5. RETAINAGE: Stephen V.Dowden,Vice-President a. 10 %of Completed Work $ _ 131,280.63 Subscribed and sworn to before me this 17TH day of JANUARY,2011 (Column +E on G703) 10 CL 5 b. 0 %of Stored 0.00 red Material $ (Column F on G703) Benjamin-PS.Strange,Notary Public My Commission Expires: 8/11/2018 Total Retainage(Lines 5a+5b or Total in Column IofG703) "� '® $ 131,280.63 ENGINEER'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE Il V $ 1,181,525.63 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) J4 p' comprising the application,the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR '' �n Engineer's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) Per 1, $ 1,107,077.63 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE `` $ 74,448.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 186,294.38 (Line 3 less Line 6) AMOUNT CERTIFIED $ 7d el'V 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 onthe Continuation Sheet that are changed to c form we h e amount certified.) in previous Change Orders $0.00 $10,480.00 Total approved this Change Order $0.00 $0.00 By: Ili. A A IN, Date: , 2�j'1, TOTALS $0.00 $10,480.00 This Ce .ficate i not -gotiable. The AMOUNT CERTIFIED is payable only tothe Contracto amen herein.Issuance,payment and acceptance of payment are without NET CHANGES by Change Order ($10,480.00) prejudice to a ry ights 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 Users may obtain validation of this document by requesting a completed AIA Document 0401 -Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 1 of 2 To: From: Project: _ Application No. . S E.V E N Carmel Theater Development Corp., LLC Indiana Steel Fabricating, Inc. VOG - Parcel 7-C-1 Theater Building Application Date: 1/17/11 11711 North Pennsylvania Street - Suite 200 4545 West Bradbury Avenue 3rd Avenue SW Period To: 1/30/11 Carmel, Indiana 46032 Indianapolis, Indiana 46241 Carmel, Indiana 46032 Engineer's Project No. . 12012 A B C C Changes D 1 E F G H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled Change From Previous Stored and Stored % To If # Description of Work Value Orders Application This Period (Not in To Date (G/C) Finish Variable D or E) (D+E+F) (C-G) 105-1000 Structural Steel 683,000.00 0.00 683,000.00 0.00 0.00 683,000.00 100% 0.00 68,300.00 105-1001 Steel Joist 21,985.00 0.00 21,985.00 0.00 0.00 21,985.00 100% 0.00 2,198.50 105-1002 Steel Deck 41,170.00 0.00 41,170.00 0.00 0.00 41,170.00 100% 0.00 4,117.00 105-1003 Grating 39,000.00 0.00 39,000.00 0.00 0.00 39,000.00 100% 0.00 3,900.00 105-1004 Steel Stairs and Rails 31,800.00 0.00 31,800.00 0.00 0.00 31,800.00 100% 0.00 3,180.00 105-1005 Miscellaneous Metals 81,045.00 0.00 0.00 57,131.25 0.00 57,131.25 , 70% 23,913.75 5,713.13 105-1006 Structural Steel Erection 380,000.00 0.00 364,826.25 15,173.75 0.00 380,000.00 100% 0.00 38,000.00 105-1007 Miscellaneous Steel Erection 40,000.00 0.00 20,000.00 2,000.00 0.00 22,000.00 55% 18,000.00 2,200.00 105-1008 Performance and Payment Bond 10,300.00 0.00 10,300.00 0.00 0.00 10,300.00 100% 0.00 1,030.00 105-1009 Allowance 50,000.00 0.00 28,485.00 8,415.00 0.00 36,900.00 74% 13,100.00 3,690.00 I 105-1010 Change Order Number: 43 (Tax Exemption) (10,480.00) 0.00 (10,480.00) 0.00 0.00 (10,480.00) 100% 0.00 (1,048.00) 1,367,820.00 0.00 1,230,086.25 82,720.00 0.00 1,312,806.25 96% 55,013.75 131,280.63 G703 CONTINUATION SHEET Page 2 of 2 To: From: Project: Application No. : S E V E N Carmel Theater Development Corp., LLC Indiana Steel Fabricating, Inc. VOG - Parcel 7-C-1 Theater Building Application Date: 1/17/11 11711 North Pennsylvania Street - Suite 200 4545 West Bradbury Avenue 3rd Avenue 5W Period To: 1/30/11 Carmel, Indiana 46032 Indianapolis, Indiana 46241 Carmel, Indiana 46032 Engineer's Project No. : 12012 A B C C Changes D I E F G H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled Change From Previous Stored and Stored % To If 6 Description of Work Value Orders Application This Period (Not in To Date (G/C) Finish Variable D or E) (D+E+F) (C-G) Change Order Number: 3 - PR.02 2,575.00 0.00 2,575.00 0.00 0.00 2,575.00 100% 0.00 257.50 Change Order Number: 5 - PR.03 4,455.00 0.00 4,455.00 0.00 0.00 4,455.00 100% 0.00 445.50 Change Order Number: 14 - PR.05 12,215.00 0.00 12,215.00 0.00 0.00 12,215.00 100% 0.00 1,221.50 Change Order Number: 15 - PR.06 3,205.00 0.00 3,205.00 0.00 0.00 3,205.00 100% 0.00 320.50 Change Order Number: 18 - PR.07 3,620.00 0.00 0.00 3,620.00 0.00 3,620.00 100% 0.00 362.00 Change Order Number: 26 - Floor Frames 1,005.00 0.00 1,005.00 0.00 0.00 1,005.00 100% 0.00 100.50 Change Order Number: 34 - PR.O11 3,550.00 0.00 3,550.00 0.00 0.00 3,550.00 100% 0.00 355.00 Change Order Number: 39 - PR.012 4,795.00 0.00 0.00 4,795.00 0.00 4,795.00 100% 0.00 479.50 Change Order Number: 41 - RFI.117 2,570.00 0.00 2,570.00 0.00 0.00 2,570.00 100% 0.00 257.00 Change Order Number: 57 - PR.014 (1,090.00) 0.00 (1,090.00) 0.00 0.00 (1,090.00) 100% 0.00 (109.00) 50,000.00 0.00 28,485.00 8,415.00 0.00 36,900.00 74% 0.00 3,690.00 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS &WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton Stephen V. Dowden Being duly sworn upon his/her oath disposes and says that: 1. He/she is Vice-President (inserting sole proprietor, partner or corporate office held, as the case maybe), of Indiana Steel Fabricating, Inc. hereafter called the "Prime Contractor". He/she is over the age of twenty-one. He/she is authorized to make this affidavit on behalf of Prime Contractor. 2. Prime Contractor is the Structural/Misc. Steel Prime Contractor for the construction of the development known as VILLAGE ON THE GREEN — PARCEL 7C1 — THEATER BUILDING located in CARMEL (City), INDIANA (state), hereafter referred to as the "Development", pursuant to the contract between the Prime Contractor and CARMEL THEATER DEVELOPMENT CORPORATION, LLC., the Owner. 3. This affidavit is made for the express purpose of inducing and CARMEL THEATER DEVELOPMENT CORPORATION, LLC., to make payment to Prime Contractor of the invoice submitted herewith for labor and materials furnished pursuant to said Contractor. Upon receipt of said payment the Prime Contractor hereby waives any lien rights to which Prime Contractor is entitled for labor or materials furnished for the development to the date hereof. 4. Listed below are all suppliers or other persons who either has furnished or might furnish the Prime Contractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered to the Owner. 3.) If the initial delivery has not been made. Supplier List(Add List if Necessary) 1. Amount Owed 2. 3. Millennium Steel, Inc. 17,173.75 New Millennium Building Systems X Canam Steel Corporation X American Stair Corporation X Indiana Gratings, Inc. X #1 and 2 correspond to the same numbered choices on the waiver format. CARMEL THEATER DEVELOPMENT CORPORATION, LLC. is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly payable to Prime Contractor and such creditor, as CARMEL THEATER DEVELOPMENT CORPORATION, LLC. shall determine. 5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result in lien being filed against the Development or a claim being asserted against the Owner except the persons or businesses named in Paragraph 4 above. IN WITNESS WHERE OF, affiant has signed this docum:+`I •;be. -If oft e Prime Contractor this 17TH day of JANUARY , 20 11. ' � Stephen V. Do den, Vice-President County of MARION State of INDIANA Subscribed and sworn to before me, a Notary Public in and for said County and State, This 17TH Day of .IANIIARY , 2011 (Notary Public) Benjamin D. Strange My Commission Expires: 8/11/2018 NOTARY SEAL MUST APPEAR ON THIS FORM. 1