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CHANCE BROS, MARBLE & TILE, INC. - 1002 - 22,680.00 - 8/2/2010 IA1 &ik Document G702/CMa1M ® 1992 , Application and Certificate for Payment Construction Manager-Adviser Edition Col TO OWNER: PROJECT: - APPLICATION NO: t - Distribution to: CITY OF CARMEL REDEVELOPMENT COMMISSION PERIOD TO OWNER ❑ 1 CIVIC.SQUARE ._-. THREE - CARMEL, IN 46032 CARMEL PERFORMING ARTS 05/15/10 CONSTRUCTION MANAGER ill FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: CERAMIC TILE ARCHITECT ❑ Chance Eros- Marble&Tile, Inc. • PROJECT NOS: / / CONTRACTOR ❑ 114 W. McCartySt., VIA ARCHITECT: CSO ARCNETECTS FIELD D CONTRACT Inapolis,IN 46225 ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge. information and Application is made for payment.as shown below,in connection with the Contract helict the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet.AIA Document G703 is attached Contract Documents that all amounts have.been paid by the Contractor for Work for which previous 221495.00 Certificates far Payment w. . issue nd payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM n is 110 •4ue. 2-Net change by Change Orders $ -17500,00 CONTRACTr,! ? 1 C . e Bros. Marble&Tile;Inc 5/10/2010 3.CONTRACT SUM TO DATE I in. 1 ±2) $ 203995.00 B AI uj. • ` ILLSNna J ( ) y: llate ar'r :1 i, • TORED,TO DATE(Column G on 0703) $ 113000.00 State o i r yx id 5.RETAfNAG�of Complct County of. ' Ion '•t V } �r •,C 4.TOTAL C �_� ed Work 11300.00 Subscribed and SW0111 to bc.. c � ' ' s .,t (Column D+E on G703) S ate this 10 day.of MAY 2010' ,i e I b. %of Stored Material Notary Public cnL-�_A ,)-fir L..r. ,t t'. )' • ,c r `h eolumn F on G703) $ 0.00 My Commission expires: 7- Iii r er ;•` d Total Retainage(Lines5a+5bor Total in Column Iof6703). $ 11300 00 CERTIFICATE FOR PAYMENT r, ,�"r 0/ r : ';: t .'+ 101700.OD In accordance with the Contract Documents, based on on-site o€iservahonsianchthe:dala comprising 6.TOTAL EARNED LESS RETAINAGE $ this application,the Constmetion Manager and Architect certify to the Owneh_that,F0 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 ..... .................. $ 79020,00 accordance with the Contract Documents,and the Contractor is entitled to payment of the.AMOUNT CERTIFIED. (I.-inc 5 from prior Certificate) Cie B.CURRENT PAYMENT DUE $ 22550.00 AMOUNT CERTIFIED - $ 22 (pBO' 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach erplanurian if amount certified differ 1 from ' amount applied.Initial all figures ud this 102295 00 /Application and on t ['mammalian Sh°'t that a rgrd to co form with the amount ceri fed.) (Line 3 less Line 6) $ CONS CTION t rr+J (/ Y t _ �Agdm/' - Date: ®?IZ�J/lam ADDITIONS DEDUC'1'IONti :' Aii CHANGE ORDER SUMMAKY ARCH( Total changes approved-in previous months by Owner $ 0.00 $ -17500.00 By: Date: C.21. • to 'Total approved'this Month S 0.00 S 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TO-I-ALS $ 0.00 5 -17500.DO named herein, Issuance) payment and acceptance of payment vt tho t judicfimany rithtijl,rjO NET CHANGES by Change Order 9 -17500.00 the Owner or Contractor under this Contract- �iM /�{J� 99 LLY++ -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. AIR Document G7921CMa^•-1992.Copyright 01992 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 docurneni when completed,To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia org. T • I Document G7O3TM - 1992 Continuation Sheet AlA DocumentG702r".Application and Certification for Payment, APPLICATION NO. ontaiContractor'S.Sil ne m d certification', attached. CARMEL PERFORMING ARTS • THREE c APPLICATI ON DATE: In tabulations below amounts are stated to the nearest dollar. 5/10/2010 Use Calunin I en Conitacts where variable retainagc for line items may apply. PERIOD TO. ARCHITECT'S PROJECT NO 5115)2010 A B t I) E e c It 1 WORK COM PLE l ED 1'07>ll. MATERIALS BALANCE FROM pR EIOUS COMPLETED SCHEDULED PRGSF-RED % NI RETAINAUE fI 5 UESCRII'T1ON Of WORK AND 57OREU NO. VALUE APPLICA LION THIS PY,.RIUI) STORED - 'TO DATE (G-CJ I'INISII (Ifrariohfa rurel (p+F.) (,yotinUorr`1 (D+L:!'J lC-G) CERAMIC TILE MOBILIZATION 500.00 500.00 0.00 0.00 500,00 100% 0.00 50.00 BOND 1,800.00 1,80000 000 0.00 1800.00 100% 0.00 180.00 ALLOWANCE#2 20,000.00 10,000.00 0.00 0-00 10,000.00 50% 10,000.00 1,900 on ALLOWANCE 4 6 5,000.00 5,000.00 0.00 0.00 5,000.00 100% 0.00 500.00 Co. . N 1 (2,500.00) 0-00 0.00 0.00 0.00 0% (2,500.00) 0.00 C O #2 - - (15,000.00) (15,000.00) 0.00 0 00 (15,000-00) 100% 0.00 (1,SOO DD)- Co. .0-3 0.00 0-00 0.00 0.00 - 0.00 NDIV/01 0.00 0.00 BASEMENT R.R.S.: LABOR 3,800.00 3,800.00 0.00 0.00 3,800.00 100% 0.00 380.00 MATERIAL ',900.00 5,900.00 0.00 0.00 5,900.00 100% 0.00 590.00 PLENUM RRS LABOR 30,400.00 15,200.00 15,200.00 - 0.00 30,40000 100% 0.00 3.040.00 MATERIAL 45,600.00 45,600.00 0,00 0.00 45,600.00 100% 0.00 4,560,00 NORTH BOX TIER ....LABOR - 17,600.00 0.00 0.00 0.00 0.00 0% 17,600-00 D.00 MATERIAL 26,400.00 0.00 0.00 0-00 0 00 t, 0% 25,400.00 0.00 - - GRAND TOTAL 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 G703,34-1992.Copyright 01963,1965, 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.Unauthorised 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,a-mail The American Institute of Architects legal counsel,copyright@aiaerg. .v/4 I Document G703TM - 1992 Continuation Sheet .- AlA Document G702T`1,Application and Certification for Payment, APPLICATION NO containing C,amractor'ssigned cerritication is attached. CARMEL PERFORMING ARTS PG N 2 In tabulations below',"amotints arc stated to the nearest dollar. APPLICATION DATE: Use Column I on Contractsw,-here variable retainage for line items inav apply. PERIOD TO ARCHITECTS PROJECT NO A .... It C D I E F G H I WORK COMPLETED TOTAL MATERIALS BALANCE COMPLETED SCHEDULED FROM PREVIOUS PRESENTLY TO RETAINAGli 1'frod DESCRIPTION'OF WORK AND APPLICATION HIS STORED AAU SIORED T (G-L'I FINISH Ofcuriable rule) NO Not TO DATE NORTH ORCHESTRA LOW LABOR 10,000.00 0.00 10,000.00 0.30 10,000.00 100% 0.00 1,000.00 MATERIAL 15,000.00 15,000,00 0.00 0.00 15,000.00 100% ` . 0.00 1,50000 BALCONY HIGH LABOR 16,000.00 0,00 0.00 0.00 0.00 0% 16,000.00 0.00 MATERIAL 23,495.00 0,00 0.00 0,00 -- 0.00 0% 23,495.00 0.00 , TOTAL GRAn'D TUTAL i 203,995.00 I 87,800.00 25,200 00 0.00 113,000.00 55% 90,995.00 11 300 00 _ 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 6703TM—1992,Copyright©1963, 1965,1966,1967, 1970,1978,1963 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 AIAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extant possible under the law. Purchasers are permitted to reproduce ten Oa)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects legal counsel,copyright cttaia.org.