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HomeMy WebLinkAboutLITHKO CONTRACTING, INC.- 151- 1/5/2011 Lithko Contracting, Inc. Check: 151 ; PO Box 270 Date: 1/5/2011 Monroe, OH 45050 Vendor: LITHKO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 9 6,231.51 6,231.51 0.00 0.00 6,231.51 Place/Finish concrete 6,231.51 6,231.51 0.00 0.00 6,231.51 151 1/5/2011 ***********6,231.51 THE SUM OF SIX THOUSAND TWO HUNDRED THIRTY ONE DOLLARS AND 51 CENTS ************** Lithko Contracting, Inc. PO Box 270 Monroe, OH 45050 Lithko Contracting, Inc. Check: 151 PO Box 270 Date: 1/5/2011 Monroe, OH 45050 Vendor: LITHKO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 9 6,231.51 6,231.51 0.00 0.00 6,231.51 Place/Finish concrete 6,231.51 6,231.51 0.00 0.00 6,231.51 / eet'LlUA 9 PUN ANL) C.tK 19F-iL.A 9 !UN A-UK F'AYNM!N I AIA DOCUMENT G702 PAGE ONE OF PAGES TO OWNER: PROJECT: VILLAGE ON THE APPLICATION NO: 9 Distribution to: CARMEL THEATRE DEVELOPMENT COMPANY,LI GREEN THEATRE PERIOD TO: November 30,2010 'OWNER 11711 NORTH PENNSLYVANIA ST., SUITE 200 BLDG. PROJECT NOS: 12012 (ARCHITECT CARMEL,IN 46032 LCI JOB# L5626 (CONTRACTOR FROM CONTRACTOR: CHECK REMITTANCE ADDRESS: I CONTRACT DATE: _ LITHKO CONTRACTING,INC LITHKO CONTRACTING,INC. P.O. BOX 270 P.O.BOX 270 MONROE, OHIO 45050 MONROE, OHIO 45050 CONTRACT FOR: Place/Finish Concrete VIA ARCHITECT: 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 $ 1,064,104.00 2. Net change by Change Orders $ (2,791.00) CONTRACTOR: LITHKO CONTRACTING,INC. 3. CONTRACT SUM TO DATE(Line 1 ±2) $ 1,061,313.00 4. TOTAL COMPLETED&STORED TO $ 1,017,737.49 DATE (Column G on G703) By: A4 1L if $.4101_•d.. •A L V Date: November 18,2010 5. RETAINAGE: ANDREA GA ON, t G COORDIN, . O' ,_.. a. 10% %of Completed Work $ 101,773.75 State of: OHIO , ,���ou ,�+o°: WARREN (Column D+Eon G703) Subscribed and sworn to before me this �i .°°° .tNay o ,i v . b. %of Stored Material $ :"el.,,,. /,/,�,`pt' � ', �' (Column F on G703) Notary Public: % .' Pjfj r , ., l'G,State Of Ohio Total Retainage(Lines 5a+5b or My Commission expires: r w;'n'. ,g ;on Expires T° ma�ia,I, Total in Column I of G703) $ 101,773.75 ARCHITECT'S CERT� � .� '�.� `�' ' � : �m A�(��" •.. 'a� � ., °, ,, ' 1. .4 t € E-26.,241 6. TOTAL EARNED LESS RETAINAGE $ 915,963.74 In accordance with the Contract ocu t is site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect'' -'1' dVt€ _'oe Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief`th• 'ork has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 909,732.23 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE $ 6,231.51 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE 145,349.26 (Line 3 less Line 6) AMOUNT CERTIFIED $ (; j/, 5 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 conform with the amount certified.) in previous months by Owner $18,753.00 $18,604.00 A: =' €: at au,,,,N.-.).P. t' 79 Total approved this Month $0.00 $2,940.00 By: �1 /^/�/. �� Date: / Z,/'3/,c TOTALS $18,753.00 $21,544.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,payment and acceptance of payment are without NET CHANGES by Change Order ($2,791.00) 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 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. P/ 7 - JMP92-22-F Effective-1/31/01 Page 1 of I T CONTINUATION SHEET MA DOCUMENT G703 PAGE OF PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 9 Contractor's signed certification is attached. APPLICATION DATE: 11/18/2010 _ In tabulations below, amounts are stated to the nearest dollar. ''* PERIOD TO: 11/30/2010 Use Column I on Contracts where variable retainage for line items may apply. CONTRACTING, �INC. ARCHITECT'S PROJECT NO: '12012 • VILLAGE ON THE GREEN THEATRE BLDG. L5626 A B C D I E F 0 . H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (0=C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (NOT IN TO DATE D OR E) (D+E+F) 103-1000 JOB SETUP&MOBILIZATION 15,000.00 15,000.00 0.00 0.00 15,000.00 100% 0.00 $1,500.00 103-1001 REMOBILIZATION FOR SLABS PKG 5,000.00 4,500.00 250.00 0.00 4,750.00 95% 250.00 $475.00 103-1002 PAYMENT&PERFORMANCE BOND 14,604.00 14,604.00 0.00 0.00 14,604.00 100% 0.00 $1,460.40 103-1003 EARTH RETENTION SYSTEM 55,500.00 55,500.00 0.00 0.00 55,500.00 100% 0.00 $5,550.00 103-1004 EROSION CONTROL SILT FENCE 1,500.00 1,500.00 0.00 0.00 1,500.00 100% 0.00 $150.00 103-1005 CONSTRUCTION ENTRANCE 5,698.00 5,698.00 0.00 0.00 5,698.00 100% 0.00 $569.80 103-1006 CONCRETE WASHOUT&MAINTENANCE 7,998.00 6,798.30 399.90 0.00 7,198.20 90% 799.80 $719.82 103-1007 STORM SEWER LABOR&EQUIPMENT 6,475.00 6,475.00 0.00 0.00 6,475.00 100% 0.00 $647.50 103-1008 STORM SEWER MATERIALS 10,000.00 10,000.00 0.00 0.00 10,000.00 100% 0.00 $1,000.00 103-1009 MASS EXCAVATION OF BASEMENT 57,065.00 57,065.00 0.00 0.00 57,065.00 100% 0.00 $5,706.50 103-1010 FOOTINGS EXCAVATION 40,628.00 40,628.00 0.00 0.00 40,628.00 100% 0.00 $4,062.80 103-1011 UNDERDRAIN LABOR&EQUIPMENT 10,000.00 10,000.00 0.00 0,00 10,000.00 100% 0.00 $1,000.00 103-1012 UNDERDRAIN MATERIALS 13,500.00 13,500.00 0.00 0.00 . 13,500.00 100% 0.00 $1,350.00 103-1013 BACKFILL LABOR&EQUIPMENT 18,000.00 18,000.00 0.00 0.00 18,000.00 100% 0.00 $1,800.00 103-1014 BACKFILL MATERIALS 48,000.00 48,000.00 0.00 0.00 48,000.00 100% 0.00 $4,800.00 103-1015 CONTINUOUS DEWATERING FOR 6 MONTHS 16,000.00 16,000.00 0.00 0.00 16,000.00 100% 0.00 $1,600.00 103-1016 BITUMINOUS DAMPPROOFING 4,475.00 4,475.00 0.00 0.00 4,475.00 100% 0.00 $447.50 103-1017 BENTONITE WATERPROOFING 29,000.00 29,000.00 0.00 0,00 29,000.00 100% 0.00 $2,900.00 103-1018 FURNISH ANCHOR BOLTS 2,200.00 2,200.00 0.00 0.00 2,200.00 100% 0.00 $220.00 103-1019 FURNISH MISC.EMBED METALS 10,800.00 10,800.00 0.00 0.00 10,800.00 100% 0.00 $1,080.00 103-1020 REINFORCING MATERIALS FOUNDATIONS 22,600.00 22,600.00 0.00 0.00 22,600.00 100% 0.00 $2,260.00 103-1021 REINFORCING MATERIALS FOR WALLS 32,000.00 32,000.00 0.00 0.00 32,000.00 100% 0.00 $3,200.00 103-1022 REINFORCING MATERIALS FOR FLATWORK 11,500.00 11,500.00 0.00 0.00 11,500.00 100% 0.00 $1,150.00 103-1023 BASEMENT FOUNDATIONS LABOR&EQUIP 19,500.00 19,500.00 0.00 0.00 19,500.00 100% 0.00 $1,950.00 103-1024 BASEMENT FOUNDATIONS MATERIALS 30,500.00 30,500.00 0.00 0.00 30,500.00 100% 0.00 $3,050.00 103-1025 BASEMENT WALLS LABOR&EQUIP 72,150.00 72,150.00 0.00 0.00 72,150.00 100% 0.00 $7,215.00 103-1026 BASEMENT WALLS MATERIAL 48,000.00 48,000.00 0.00 0.00 48,000.00 100% 0.00 $4,800.00 Page 1 of JMP92-20-F Effective-1/31/01 , v IL1Ld-Viirr. %JUN 1 Fill a.r.runr 1 Xi r.Li.1 K d', ra"ALP -. L5626 - A B C D ( 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 (IF VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (NOT IN TO DATE D OR E) (D+E+F) _ 103-1027 TRAP RM MAT FNDTN LABOR&EQUIP 3,500.00 3,500.00 0.00 0.00 3,500.00 100% 0.00 $350.00 103-1028 TRAP RM MAT FNDTN MATERIALS 8,500.00 8,500.00 0.00 0.00 8,500.00 100% 0.00 $850.00 103-1029 ORCHESTRA PIT FNDTN LABOR&EQUIP 1,200.00 1,200.00 0.00 0.00 1,200.00 100% 0.00 $120.00 103-1030 ORCHESTRA PIT FNDTN MATERIAL 3,500.00 3,500.00 0.00 0.00 3,500.00 100% 0.00 $350.00 103-1031 ELEVATOR PIT 3,500.00 3,500.00 0.00 0.00 3,500.00 100% 0.00 $350.00 103-1032 NORTHSIDE FOUNDATIONS LABOR&EQUIP 22,500.00 22,500.00 0.00 0.00 22,500.00 100% 0.00 $2,250.00 103-1033 NORTHSIDE FOUNDATIONS MATERIALS 62,000.00 62,000.00 0.00 0.00 62,000.00 100% 0.00 $6,200.00 103-1034 ISOATED PIERS LABOR&EQUIPMENT 2,200.00 2,200.00 0.00 0.00 2,200.00 100% 0.00 $220.00 103-1035 ISOLATED PIERS MATERIALS 1,300.00 1,300.00 0.00 0.00 1,300.00 100% 0.00 $130.00 103-1036 DOCK WALL FOUNDATIONS LABOR&EQUIP 750.00 750.00 0.00 0.00 750.00 100% 0.00 $75.00 103-1037 DOCK WALL FOUNDATIONS MATERIALS 1,000.00 1,000.00 0.00 0.00 1,000.00 100% 0.00 $100.00 103-1038 DOCK WALL LABOR&EQUIPMENT 3,000.00 3,000.00 0.00 0.00 3,000.00 100% 0.00 $300.00 103-1039 DOCK WALL MATERIALS 2,000.00 2,000.00 0.00 0.00 2,000.00 100% 0.00 $200.00 103-1040 DOCK AREA TRENCH DRAIN 1,500.00 1,500.00 0.00 0.00 1,500.00 100% 0.00 $150.00 103-1041 NORTHSIDE STEM WALLS LABOR&EQUIP. 23,600.00 23,600.00 0.00 0.00 23,600.00 100% 0.00 $2,360.00 103-1042 NORTHSIDE STEM WALLS MATERIALS 18,500.00 18,500.00 0.00 0.00 18,500.00 100% 0.00 $1,850.00 103-1043 NORTH INTERIOR TALL WALLS LABOR&EQUIP 38,000.00 38,000.00 0.00 0.00 38,000.00 100% 0.00 $3,800.00 103-1044 NORTH INTERIOR TALL WALLS MATERIALS 25,011.00 25,011.00 0.00 0.00 25,011.00 100% 0.00 $2,501.10 103-1045 INTERIOR CURBS 1,200.00 0.00 0.00 0.00 0.00 0% 1,200.00 $0.00 103-1046 STAIRS ON GRADE-RISERS&LANDIGS 5,000.00 5,000.00 0.00 0.00 5,000.00 100% 0.00 $500.00 103-1047 SLAB ON GRADE STONE BASE INSTALLATION 2,500.00 2,250.00 125.00 0.00 2,375.00 95% 125.00 $237.50 103-1048 SLAB ON GRADE STONE BASE MATERIAL 8,700.00 7,830.00 435.00 0.00 8,265.00 95% 435.00 $826.50 103-1049 SLAB ON GRADE LABOR&EQUIPMENT 27,000.00 24,300.00 540.00 0.00 24,840.00 92% 2,160.00 $2,484.00 103-1050 SLAB ON GRADE MATERIALS 35,000.00 31,500.00 700.00 0.00 32,200.00 92% 2,800.00 $3,220.00 103-1051 STADIUM RISERS LABOR&EQUIPMENT 13,000.00 0.00 0.00 0.00 0.00 0% 13,000.00 $0.00 103-1052 STADIUM RISERS MATERIALS 15,000.00 0.00 0.00 0.00 0.00 0% 15,000.00 $0.00 103-1053 SLAB ON METAL DECK LABOR&EQUIP 38,300.00 32,555.00 3,064.00 0.00 35,619.00 93% 2,681.00 $3,561.90 103-1054 SLAB ON METAL DECK MATERIALS 15,500.00 13,175.00 1,240.00 0.00 14,415.00 930/s 1,085.00 $1,441.50 103-1055 TRAP ROOM TOPPING SLAB 750.00 0.00 0.00 0.00 0.00 0% 750.00 $0.00 103-1056 PAN STAIRS LABOR&EQUIPMENT 2,100.00 2,100,00 0.00 0.00 2,100.00 100% 0.00 $210.00 103-1057 PAN STAIRS MATERIAL 900.00 900,00 0.00 0.00 900.00 100% 0.00 $90.00 103-1058 EXTERIOR PAVING STONE BASE INSTALL 800.00 800.00 0.00 0.00 800.00 100% 0.00 $80.00 103-1059 EXTERIOR PAVING STONE BASE MATERIALS 1,300.00 1,300,00 0.00 0.00 1,300.00 100% 0.00 $130.00 Page 2 of 3 JMP92-20-F Eff✓ctive-1/31/01 V RL1tINTd� IL"111 1111. II 'r.1V 1 Jul r.d-i1ycr, i j jj T. .. L5626 - A B C _ D 1 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 (IF VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (NOT IN TO DATE D OR E) (D+E+F) 103-1060 EXTERIOR PAVING LABOR&EQUIPMENT 4,400.00 4,400.00 0.00 0.00 4,400.00 100% 0.00 $440.00 103-1061 EXTERIOR PAVING MATERIALS 8,000.00 8,000.00 0.00 0.00 8,000.00 100% 0.00 $800.00 103-1062 EXTERIOR PAVEMENT JOINT SEALANTS 800.00 0.00 0.00 0.00 0.00 0% 800.00 $0.00 103-1063 STOOPS LABOR AND EQUIPMENT 2,200.00 2,090.00 110.00 0.00 2,200.00 100% 0.00 $220.00 103-1064 STOOPS MATERIALS 1,500.00 1,425.00 75.00 0.00 1,500.00 100% 0.00 $150.00 103-1065 DECORATIVE BOLLARDS LABOR&EQUIP 1,500.00 1,500.00 0.00 0.00 1,500.00 100% 0.00 $150.00 103-1066 DECORATIVE BOLLARDS MATERIALS 3,200.00 3,200.00 0.00 0.00 3,200.00 100% 0.00 $320.00 103-1067 SITE CONCRETE 1,200.00 480.00 720.00 0.00 1,200.00 100% 0.00 $120.00 103-1068 ALLOWANCE-45000.00 SEE BELOW 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00 C0.01 PR001 (16089) 16,089.00 16,089.00 0.00 0.00 16,089.00 100% 0.00 $1,608.90 C0.06 PR003(9735) 9,735.00 7,301.25 0.00 0.00 7,301.25 75% 2,433.75 $730.13 C0.08 PROO4(504) 504.00 504.00 0.00 0.00 504.00 100% 0.00 $50.40 C0.02-PR002(13976) 13,976.00 13,976.00 0.00 0.00 13,976.00 100% 0.00 $1,397.60 C0.12-PR005(1168) 1,168.00 0.00 0.00 0.00 0.00 0% 1,168.00 $0.00 C0.16-PR006(ALLOW AUTH 2024) 2,024.00 931.04 0.00 0.00 931.04 46% 1,092.96 $93.10 C0.21-PR007(ALLOW AUTH 0.00) 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00 CO.22 UNFORSEEN COND(ALLOW AUTH 1504) 1,504.00 1,504.00 0.00 0.00 1,504.00 100% 0.00 $150.40 103-1069 CO.22 UNFORSEEN COND -15,853 15,853.00 15,853.00 0.00 0.00 15,853.00 100% 0.00 $1,585.30 103-1070 CO#24 VOG.7C1.CO.24 ELIMINATE BOND -14,604.00 -14,604.00 0.00 0.00 (14,604.00) 100% 0.00 ($1,460.40) 103-1071 CO.27 VOG.7C1.CO.27 ELIMINATE STORM SEWER -4,000.00 -4,000.00 0.00 0.00 (4,000.00) 100% 0.00 ($400.00) 103-1072 CO.32 VOG.7C1CO.32.ASI.007-ALLEY MODIFICAT 2,900.00 2,900.00 0.00 0.00 2,900.00 100% 0.00 $290.00 103-1073 C0.51 TAX EXEMPT -2,940.00 0.00 -735.00 0.00 (735.00) 25% (2,205.00) ($73.50) 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0% 0.00 , $0.00 GRAND TOTALS 1,061,313.00 1,010,813.59 6,923.90 0.00 1,017,737.49 96% 43,575.51 $101,773.75 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 -Certification of Document's Authenticity Page 3 of 3 JMP92-20-F Effective-1/31/01 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS &WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton Matt Ahlquist Being duly sworn upon his/her oath disposes and says that: 1. He is Area Lead of Lithko Contracting, 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. Lithko Contracting is the 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. Attached are all suppliers or other persons who either have 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. #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 do ment on beh- of the Prime Contractor this '17—fl-9- day of NiQVmo , 20 `42 ar • ,, Authorzed Repres- tative of Prime Contractor, Title) County of .;io■v ) /k L4 -D 1 ND(AN Mot-4,.. 0 vit State of _77U ) Subscribed and sworn to before me, a Notary Public in and for said County and State, 20 :,, This ��!� Day of od� e D z ,' . .• „ .„...;4gtrip :-- ,C7f1 ' / , 1 , Ada lc0"( • ( —, (Nota Public) e' ••• ° °,�'�i 4`r s G': o ,; / ,,sii. Printed Name) : ®g My Commission Expires: p�gp/ f ti:s o {NOTARY SEAL MUST APPAR ON THIS FORM. `. ° P •°• ,T - 1 Lithko Contracting Waiver Log Village on the Green-Parcel 7C1 -Theater Building Supplier Amount Amount Amount Un-Conditional No Supplier Notes Owed Paid Outstanding Supplier Waiver Final Supplier Delivery Attached Waiver Attached Amount owed through October waivers Ram Engineering $ 53,500.00 $ 48,150.00 $ 5,350.00 X X through September Amount owed through October waivers Sub-Surface of Indiana $ 223,038.00 $ 200,734.20 $ 22,303.80 X X through September Amount owed through October waivers Circle City Reinforcing $ 68,559.39 $ 68,559.39 $ - X X through September Amount owed through October waivers Builders Concrete $ 136,228.45 $ 116,038.00 $ 20,190.45 X . through September • Supplier Log for Waivers-November Pay App.xls L562B UNCONDITIONAL PARTIAL WAIVER OF LIEN PROTECT! Village on the Green-Parcel 7-C-1 Theater Building .,._. The undersigned,in consideration of Zero billed in Sep.,2010 ,receipt of which is hereby acknowledged, does hereby release any right to a mechanic's lien,any state or federal statutory bond right,any private bond right,and any further claim for payment,with the exception of retainer held if applicable,for all labor,services,equipment or material furnished thru September 30,2010 to LG CONTRACTING,INC. (Perm wrth two un'ersignad atnntraeled) on the job of Carmel Theater Development Co •oration,LLC [ammo located at 3rd Avenue,SW, Cannel,IN 46032 (J o. ... . .) The undersigned wan-ants that he has paid or will pay in full from these afonnentioned Bands all of his laborers,subcontractors,materialmen and suppliers for all work, materials,equipment or services provided thru the above date for or to the above referenced project_ Date- ...111p9“1 1 __ Circle City ic) F V I•5 A.c1 ,c+ (Plops typo in adlhoriod Finnic St titic) STATE OF: ` r`d t O n Q COUNTY OF: \t r- Subscribed and sworn to before me this .'-1+t.. day of 1...1 nV Lrr,l er ,20 1 v. C—P J`crre 15, .lot 8 Notary i i • My commission expires SEAL gr Phyllis.i.Kording e Nntnry Public,State of Indiana N;<%;>�.;,, r County of Residence,Marion �qre ('oo inix.inn Exp.Juno 15,2018 L5626 UNCONDITIONAL PARTIAL WAIVER OP LIEN PROJECT: Village on the Green-Parcel 7-C-1 Theater Building The undersigned,in consideration of $ 20,985.43 ,receipt of which is hereby acknowledged, does hereby release any right to a mechanic's lien,any state or federal statutory bond right, any private bond right,and any further claim for payment,with the exception of retainer held if applicable,for all labor,services,equipment or material furnished thru September 30,2010 to LITHKO CONTRACTING,INC. (Person with whom undersigned contracted) on the job of Carmel Theater Development Corporation,LLC (Owner) located at 3rd Avenue, SW, Carmel,IN 46032 (Job Address) The undersigned warrants that he has paid or will pay in full from these aformentioned funds all of his laborers,subcontractors,materialmen and suppliers for all work, materials,equipment or services provided thru the above date for or to the above referenced project. Date: Builders Concrete&Supply Co.,Inc. (Company Name) (Signatui �� . i1► tie (Please type in authorize,name&t tle) STATE OF: ri A COUNTY OF: kAIMILTDA Subscrib,d and s t. ,e ore me this \fib day of _�j� f 1 }—,20 ID �.►..4 I. 1 11 , 4.,11.111 Votary My commission expires L5626 UNCONDITIONAL PART,WAIVER OF LIEN PROJECT: Villa_e on the Green-Parcel 7-C-1 Theater Building The undersigned,in consideration of Zero billed in Sep.,2010 ,receipt of which is hereby acknowledged, does hereby release any right to a mechanic's lien,any state or federal statutory bond right,any private bond right,and any further claim for payment,with the exception of retainer held if applicable,for all labor,services,equipment or material furnished thru September 30,2010 to LITIIKO CONTRACTING,INC. (Anon with whom undersigned eontmctcd) on the job of Cannel Theater Develo.meat Cor.oration,LLC ( cr located at 3rd Avenue, SW, Carmel,IN 46032 (rob Address) The undersigned warrants that be has paid or will pay in full from these aformentioncd funds all of his Taborets, subcontractors,materialmen and suppliers for all work, materials,equipment or services provided thru the above date for or to the above referenced project. Date: IA/c v. 2 O/O Sub Surface of Indiana,Inc. Seal Stateotfndiana (Sit/melte) JFFREY> "roll R ur•rt< Psi Al tA+ Resident of sfehnson Co. (Please type in authorized rune&title) aiv CO' -1s n Expires p;^ri 228,2012 STATE OF: COUNTY OF: j-0'h h cf G n Subscribed and sworn,to betb e me this 74-A day of N C v- ,20 /d Notary d M,y commission expires L5826 'UNCONDITIONAL PARTIAL WAIVER OF LIEN PROJECT. Village on the Green•-Parcel 7-C-I Theater Building The undersigned,in consideration of Zero billed in Sept,2010 ,receipt of which is hereby acknowledged, does hereby release any right to a mechanic's lien,any state or federal statutory bond right,any private bond right,and any further claim for payment,with the exception of retainer held if applicable,for all labor,services,equipment or material furnished thin Se'tember 30,2010 to LJTHKO CONTRACTING,INC. (Person vritb whom undamped contracted) on the job of Carmel Theater Development Cor oration,LLC ( ). located at 3rd Avenue, SW, Carmel,IN 46032 (obA..ress) The undersigned warrants that he has paid or will pay in full from These afonncntioned funds all of his laborers,subcontractors,materialmen and suppliers for all work, materials,equipment or services provided thru the above date for or to the above referenced project. Date: ..tlouPmr 4 Zl _ RAM ll nginee'lag&` I.nstr etion .. 'smote) W. W. Chilton, III, Vice President (Please typo in authorized n mo&lido) STATE OF; KENYUGKY . COUNTY OF: JEFFERSON Subseri er and sworn 'before me this 4 t _day of November ,20 l0 J .4,40 2/4/2011 No ,'t"'• My commission expires