M.A.B. & ASSOCIATES, INC.- 001434- 12/2/2010 f ' .
CARMEL REDEVELOPMENT COMMISSION 0014 3 4
M.A.B. &Associates, Inc. Check: 1434
7648 Camelback Drive Date: 12/2/2010
Indianapolis, IN 46250 Vendor: MAB &Al
Prior •
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
10 40 12,471.00 12,471.00 0.00 0.00 12,471.00
Application 10
12,471.00 12,471.00 0.00 0.00 12,471.00
B THISICHECKINAVAT COLTO REDIBAC KGROUNDTANDICONTAINS*MUETIREEMECURITAIEEATURESs°-SEE{BACK=EOR3DETAiLS' 1eJRE .
i : 6: ESC� Carmel Redevelopment Commission
0;01434
rp
30 West Main Street A REGIONS
Suite 220 '- • 20-1421/740
CARMEL
0/ el Carmel, IN 46032
1434
. DATE AMOUNT
• 12/2/201.0 - ************12,471.00
PAY THE SUM OF TWELVE THOUSAND FOUR HUNDRED SEVENTY ONE DOLLARS
TO THE
ORDER -
°F M.A.B. &Associates, Inc.
7648 Camelback Drive 1 t SENS,,m
Indianapolis, IN 46250 '
4gEA T0� _ ____ hp
0001,434o I:0 740 01 2 1, 3i: 008 7 E04 1, 3, W
CARMEL REDEVELOPMENT COMMISSION 0 014 3 4
M.A.B. &Associates, Inc. Check: 1434
7648 Camelback Drive Date: 12/2/2010
Indianapolis, IN 46250 Vendor: MAB &Al
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Pai
10 40 12,471.00 12,471.00 0.00 0.00 12,471.0
Application 10
12,471.00 12,471.00 0.00 0.00 12,471.0
IMP.%= Document 6702/CMaT1A — 1992
Application and Certificate for Payment Construction Manager-Adviser Edition y0
TO OWNER: PROJECT: 0A 144,..t 44 C4-4, S li ' s APPLICATION NO: /U Distribution to:
2,Se�,.Ga „t.7- 0444.,~.
C�r2M� P' PERIOD TO: ii,to ho OWNER ❑
04.( 0,„. CONSTRUCTION MANAGER ❑
FROM CONTRACTOR: , ViA C''/7y�NS/��p`UCTI MANAGER: CONTRACT DATE: 2/2.71 o' ARCHITECT ❑
g A�pc-„a Ter, ..s C. Slv'.4 r .54 if A^”- PROJECT NOS: 26/c/3/2C I CONTRACTOR ❑
6c p aim eL N' t7,,. car—rpcTi FIELD ❑
X61 f� VIA ARCHITECT: e-SO A
�r--,.v.,�Ap•i,i
CONTRACT FOR: ,0_' ❑
�r��..A ��1,vA,a�T-4/ go 122L74.1.
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
Continuation Sheet,AIA Document G703,is attached. -- . es or 'ay ere issued and payments received from the Owner, and that current
1.ORIGINAL CONTRACT SUM $ 2.53. �g2— payment shown herein now e-
$ /D Z 7 S RACTOR: 41,47 1 r.'t•
2.Net change by Change Orders r
3.CONTRACT SUM TO DATE(Line I ±2)
$ `Z(c,� /5-7 BY: �'1..:.�...r _ 1 Date: !O/ 1, 4.,
4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 25 1,, tQ' State of: , ti
5.RETAINAGE: County of: a--%
a. %of Completed Work Subscribed and sworn to befor Aire�'4� DImvfI@
(Column D+Eon G703) $ me this .t2 ,a • + � / r � 'a o,. °• Resident a
Notary Public: ; ■fi / `�r~f3 ie= Marion County
b. %of Stored Material l �'w;0. Commission Espial:
(Column F on G703) $ My Commiss'on pt s. _ ' ,_
(,s
CERTIFICATE FOR PAYMENT
Total Retainage(Lines 5a+5b or Total in Column 1 of G703). $ %j Za 7.D
In accordance with the Contract Documents,based on on-site observations and the data comprising
6.TOTAL EARNED LESS RETAINAGE $ 2_`i'2t ' .4S this application,the Construction Manager and Architect certify to the Owner that to the best of their
��
(Line 4 Less Line 5 Total) - knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 2-3c, i3,/�`. accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT
CERTIFIED.
(Line 6 from prior Certificate) 'Z_ `
8.CURRENT PAYMENT DUE I $ /2, /74 t7 d I AMOUNT CERTIFIED $ `--144
(Attach explanation if amount certified differs f r the amount applied.Initial all figures on this
9.BALANCE TO FINISH,INCLUDING RETAINAGE et. Application and on the Continuation eel th, changed to conform with the amount certified.)
(Line 3 less Line 6) $ 2/ Zyb , CONST'- CTION t.•G R: /0/P23//0
By: =: . ,ce./../v_ .,! —.AI Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHR * _ Y
L �J' Date: L1CJ 1750 Total chanes approved in previous months by Owner $ $ By:
,J_g Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to tractor
TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Change Order $
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 67021CMa"'-1992.Copyright 0 199®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.
P.,rrhacgrS 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@aa.org.
CONTINUATION SHEET Date 10/20/2010
APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: TEN
Contractors signed Certification is attached. APPLICATION DATE: 10/14/2010
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 10/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO. 19/22
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
APPLICATION STORED AND STORED (C-G)
(D'E) (NOT IN TO DATE
D OR E) (D■E+F)
0100 Base Contract
0101 Performance&Payment Bond $ 3,870.00 $ 3,870.00 $ 3,870 00 100% $ -
0102 Detailing&Engineering $ 16,695.00 S 16,695.00 $ 16,695.00 100% $ - .
0103 Material MT 1a rail $ 15,962.00 $ 15,962.00 $ 15,962.00 100% $ -
0104 Fabrication MT 1a $ 68,191 00 $ 68,191.00 $ 68,191.00 100% $ -
0105 Installation $ 15,600 00 $ 13,820.00 $ 1,780 00 $ 15,600.00 100% $
0106 Material MT 1b $ 9,271 00 $ 9,271.00 $ 9,271.00 100% $ -
0107 Fabrication MT 1b $ 28,202.00 $ 26,101 00 $ 2,101.00 $ 28,202.00 100% $
0108 Installation $ 8,700.00 $ 4,350.00 $ 4,350 00 $ 8,700.00 100% $
0109 Material MT lc $ 9,528.00 S 9,528.00 $ 9,528.00 100% $ -
0110 Fabrlation MT1c $ 29,952.00 $ 29,952.00 _ $ 29,952 00. 100% $ -
Installation S 7,990.00 $ 3,750.00 $ 4,240 00 $ 7,790 00 100% $
Material 1-line $ 3,724.00 $ 3,724.00 $ 3,724.00 100% $ -
Fabrication $ 5,916.00 $ 1,183.00 $ 1,183.00 20% $ 4,73300
Installation $ 2,183.00 $ 2,18300
Powder Coat MT 1A $ 11,091.00 $ 11,091 00 $ 11,091.00 100% $ -
Powder Coat MT 1B $ 3,482.00 $ 3,482.00 $ 3,482.00 100%
Powder Coat MT 1C $ 7,352.00 $ 7,352.00 $ 7,352 00 100% $ -
PowderCoatSingleline $ 1,173.00 $ 1,173.00
•
Change Order#1 $ 8,460.00 $ 8,460.00 _ $ 8,460 00 100% $ -
Cash Allowance Authorization $5,000 $ 5,000.00 $ 5,000.00 100% $ -
Change Order#3 $1,815 $ 1,815.00 $ 1,815.00 100% $ -
TOTAL $ 264,157.00 $ 243,597.00 $ 12,471.00 $ - $ 256,068.00 0% $ 8,089.00 $13,207.00
•
AFFIDAVIT AND WAIVER OF LIEN
Final ! Partial Payment to follow
STATE OF INDIANA, COUNTY OF . SS: -1
being duly sworn states that he/she is the
jr
(title) (supplier or subcontractor) •
having contracted with (':E , C 4k to furnish certain material
i. ((§ontractor) ,
and/or labor as follows: � u<<- G� a;,44;..,kJ, ,c�� ,<< � �; 7 ����1y ►Z�
0/Ltic.-(description)
for the prof kno as �a-cvi 4 C��c1��y / and wned by �.-o-e:�M
located at ('��?r� � � � Y �� -
architect (i S G, and does hereby further state on behalf
of the aforementioned subcontractor/supplier.
PARTIAL WAIVER that the balance due from contractor is the sum of 15
dollars($2o/,`-�(4- )
( )receipt of which is hereby acknowledged; or
( )the payment of which has been promised as the sole consideration for this affidavit
and partial Waiver of Lien,which is given to and for said amount, effective upon receipt for
such payment;
FINAL WAIVER that the final balance due from the contractor is the sum of
dollars($ )
( )receipt of which is hereby acknowledged: or
( )the payment of which has been promised as the sole consideration for this affidavit
and partial Waiver of Lien which shall become effective upon receipt for such payment.
THEREFORE,the undersigned waives and releases unto the owner of said premises,any and
All lien of claim whatsoever on the above described property improvements thereon on account
of labor and materials, or both, furnished by the undersigned thereto, and further certifies that no
other party has any claim or right to a lien on account of any work performed or material
furnished to the undersigned . A a payment, : = within the scope of this affidavit and waiver.
e-; _ g 122.1
(name of claimant) (authorizetdrepresentati k') (title)
Witness my hand and notaria} seal,this 2c' day op V =/ isr
My commis • expires: y/3,he. -
(signatture of notary)
• Residing in e:'- County Printed
..p te. Deborah Danville
Resident 01
~sim. Mao County
•»•; My_Marten
o Ems: