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HomeMy WebLinkAboutDIVERSIFIED PAINTING COMPANY - 1196 - 380,385.46 - 9/16/2010 T 5-3 - -AIA Document G702/CMa" - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: • APPLICATION NO: 9 Distribution to Cannel Redevelopment Commission PARCEL 7A, Regional Performing Arts Center One Civic Square Interior Finish Package PS PERIOD TO: 7115110 OWNER ❑ Cannel, IN 46032 Bid Pack#5160:Painting CONSTRUCTION MANAGER ❑ FROM CONT&6¶1!$Rd Painting Company VIA CONSTRUCTION MANAGER: CONTRACT DATE: Febuary 24,2009 ARCHITECT ❑ 1681 Expo Lane CSO Architects PROJECT NOS: / 2695 / CONTRACTOR ❑ Indianapolis,IN 46214 280 E. 96th Street.Suite 100 VIA ARCHITECT: Indianapolis, IN 46240 FIELD ❑ Bid Pack 5160;Painting CONTRACT FOR: ❑ 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 helow, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents. that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet.AIA Document 6703.is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 2,Ion non DD payment shown herein is now due. 2. Net change by Change Orders S (cc c,o 00) CONTRACTOR: (:c 3.CONTRACT SUM TO DATE(Line I ±2) $ 2,044,450.00 By: Date: 7r1F[7M0 4.TOTAL COMPLETED&STORED TO DATE(Column G on 6703) $ 1,087,978.96 State of: INDIA A 5.RETAINAGE: County of: Boone _ — — a. 1 pf Completed Work Subscribed and sworn to before Thomas E. Hill (Column b+Eon 6703) 584,07200 me this day 7/i Notary Public State of Indiana 0 b. 19°70f Stored Material Notary Public: Thomas E Hilt 56-� Boone County (Column Eon 6703) $18,150.00 My Commission expires: 11/08/2017 Expires Nov 8, 2017 —sties Total Retainage(Lines 5a+51)or Total in Column l of G703).. S t02222 00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 985,756.96 In accordance with the Contract Documents. based on on-site observations and the data comprising 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 $ 710 523.D.9_ accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT PAYMENT DUE S _ 275,233.96 AMOUNT CERTIFIED $ Z1S�2 53-' 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial(7/I figures on this Application and on the Continuation Sheet that e changed to conform with the amount certified.) (Line 3 less Line 6) 1,(9,58,693.04 CONST•UCTION T •NA a—£iBY: ...(t alrat. . _ Date: 07/7.-3// 0 CHANGE ORDER SUMMARY ADDTI'IONS DEDUCTIONS ARCH/ EC • /� r� LL / 1 . --- /�^� 3�y Total changes approved in previous months by Owner S $ By: r Date: Y/ f yeJ I(pre Total approved this Month S $ This Certi 'ate not negotiable The AMOUNT CERTIFIED is payable only to the Contractor TOTALS S - $ - named herein. Issuance. payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order S - the Owner or Contractor under this Contract. \ Director of Redevelopm 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 G7021CMan,—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties. PIP° 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. Y Y 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. PAID ay 112010 S , AIA Document G702/CMaT"t - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.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/CMa,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. C.Completing the G702/CMa Form Atter the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment.Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and 6703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value 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 into the project which 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/CMa 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/CMa. E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.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/CMa. AIA Document G7021CMaTu—1992.Copyright m 1992 by The American Institute of Architects.All rights reserved.WARNING:This Alike Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlAe 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 periitted 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. tL1kIk Document G703TM1 - 1992 page Continuation Sheet : - .. AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 9 containing Contractor's si2lcd certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar- 40374 Use Column 1 on Contracts where variable retainage for line items nay apply. PERIOD TO: 7715/2010 ARCHITECT'S PROJECT NO: A B C D E I F G I I I I WORK COMPI.,F,TED MATERIALS TOTAL BALANCE SCHEDULED PRESENTLY AND STORED RPTAINAGE ITEM DESCRIPTION OF WORK FROM PREVIOUS 'IU VALUE STORED AND STORED Ilk'\`ARiARL,P. NO. APPLICATION' THIS PERIOD (NOT'[N' TO DATE K; (2) FINISH RAT'C7 (0+F,) DOR E) (D+E+F) (C-G) 1 Bonds 73,500.00 73,500.00 73,500.00 140% 0.00 7,350.00 2 Moblilization 5,000.00 5,000,00 0.00 5,000.00 100% 0.00 500.00 3 Insurance/I laze=/Safety 4,000.00 4000.00 4000.00 100% 0.00 400.00 4 Subuuttuls 4,800.00 =.800.00 4,800.00 :. 100% 0.00 480,00 5 00-72-00; WALLCOVIERING Labor 18,750.00 2,500.00 2,500.00 13% 16,250.00 250.00 Material . 37,000,00 11,009 00 11,000:00 30% 26,000.00 1,100.00 6 09-84-00;ACOUSTICAL WALL PANELS Labor 51,500.00 4,000.00 4.00000 8% 47,500.00 400.00 Material 580,000.00 5,800.00 19,000.00 181,500.00 206,30000 36% 373,700.00 20,630.00 7 09-91-00; PAINTING BASE MECH Labor 36,580.00 3665000 0.00 35,580.00 100% 0.00 3,668.00 BASE MECH Material 9,000.00 9,003.00 0.00 9,000.00 100% 0.00 900,00 BASE ELECT LABOR 10,080.00 10,080.00 0.00 10,080.00 100% 0.00 1,008 00 BASE ELECT MATER 2,500.00 2.500.00 0.00 2,500.00 100% 0.00 250.00 INT CONST BASE LAB 10,3E0.00 8,300,00 0.00 8,300.00 75% 2,530 00 830.00 INT CONST BASE MAT 2,500.00 1,500.00 0.00 1,500.00 60% 1,000.00 150,00 PLEM LABOR 8,480.00 5,000.00 0-00 5,000.00 59% 3,48000 500-00 PLEM MATERAIL 2,500.00 1,250.00 0.00 1,250.00 50% 1,250.00 125.00 CON HALT.N WALL LABOR 59,120.00 1,500.00 35,000.00 36,500.00 53% 32,620.00 3,650.00 CON HALL N WALL MATERIAL 12,500.00 500.00 9,030,00 9,500.00 .76%. 3,00000 95000 CON HALL N DOME LABOR 45,920,00 38,500.00 7,420.00 45,920.00 100% 0.00 4,592 00 CON HALL N DOME MATERIAL 15,000,00 12,100.00 2,900.00 15,000.00 100% 0.00 1,500.00 CON HALL BALY WALT,LAB 122,240.00 29,00000 69,000.00 98000.00 80% 24,240 30 9,800.00 CON FIALL BALY WAid,MAT 24,000,00 6,000.00 13,200.00 19,200.00 80% 4,800,00 1,920.00 CUB TOTAL 1511rE-; 1.145'250.00 255,010.0043 1-7'3;020.00 181,500 00 C0^_,5.7^_.00 10.21 53&420 00 x0;953.00 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 G703m-1g92.Copyright At 1963, 1965,1966,1967, 1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlAeDocument 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 at AIA Contract Documents,e-mail The American Institute of Architects legal counsel,copyright[Jataorg. = AI AT Document G703"- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.Al A Document 0702,Application and Certificate for Payment,is to be used in conjunction with AIA Document 0703,Continuation Sheet_These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use arc covered in A IA Document A201,Gencrul Conditions of the Contract for Construction. Use of Current Documents.Prior to using any AIA Contract Document,users should consult www,aia.org or it lucid MA component to verRY the most recent edition. Reproductions.This document is a copyrighted work and may not he reproduced or excerpted from without the express written permission of the Al A_There is no implied permission to reproduce this document,nor does membership hi The American Institute of Architects confer any further rights to reproduce this document.The MA hereby grams the purchaser a limited license to reproduce it maxuuunt of ten copies of a completed 0703.but only for use in connection with a particular prujccl.The A IA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of mitten permission tom the AIA. Rights to reproduce the document may vary for users of AIA software, Licensed Al A software users should consult the End User License Agreement(FULA), To report copyright violations of ALA Contract Documents.c-mail The American Institute of Architects'legal co Lief,copyrightCfain.org. COMPLETING G793-1992 (leading.This information should be completed in a manner consistent with similar information on AIA Document 6702, Application and Certificate far 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 oldie 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 button)when more than one page is used and louded 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 I)&E from the previous application).Values from column P'(Materials Presently Sloped) from the previous application should not he 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 P)_ 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 cud of each pay period.This value covers both materials newly stored for which pay meat is sought and materials previously stored which are not vet incorporated into III[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 end incorporated into column G(Work Completed—This Period.) Column C. Enter here the total elcolumns 0,G and P.Calculate the percentage completed by dividing column G by column C. Column D.Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column 1. This column is normally used only fin contracts where wrriable rctainage is permitted on a line-item basis. It need not he completed on projects where a constant retainago 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 07113 farm 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 C;702 font. 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 haft with according to Section 7.3 in A20 I. 'Che follmvfng is on c;.rumple o/n Crurrtnunnsi,r Short fin-mirk in progress, Please more that dollar mnarnis show)?hclonvrn'Jot illrrsowenr purprnrx nn/r.and are not dpi to le l to roiled nought cnns WPC r'mr costs. A LL G 0 r I' C II HONK 3.Ir1 I1'Iln NVI1611L5 To I AI. t/u 10101/rllAin r1H AIIIII'101015 IWtGIVlI,V 109 11IF1) 1HI I,I1 NAGS Vl DI''Gt 1111•a0Nr H DOR% `,,1111: \I I'l.11'M1 n�N 'I HIS PERIOD ST.Irl11 ,1KIl i[]I[LI !'�'4 M1till Inn II.\all Ln-1;1 1005 ti Tot Lr/ri 0-6/ H:.I FJ 0rrlt0 111 e,r1 1 A108LLSZAnON 5000 5,000 0 5.000 100 0 2 StVMP REMOVAL 5000 5,000 0 5.000 100 3 EARTHWORK 15000 10,00 5 000 15000 100 0 4 LOWER RETAINING WALL. 10,000 5,000 5000 50 0,000 e 0J1555 MISC.CONC. 5000 0 o 0 5,000 6 PAVING,UPPER ORtVE 20,000 0 0 D 20000 7 PAVING,LOWER CRIVE 20,000 0 0 D 20,000 fl PAVERS 20000 0 10000 10.000 50 loons 9 BRICK WORK 5000 0 0 0 0 5000 to tt 105,010 20000 10,020 10.000 40.000 66,000 ALA Document G703'"—1992.Copyright 01963,1965,1966,1967,1970, 19M,1983 and 1992 by The American institute el 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 @aid org_ tAIA Document G7Q3r ' 1992 Continuation Sheet page 2 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION:NO: containing Contrrrtur's signed dei[i licalion is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. 9 We Column Ion Contracts where variable relainage for line items may apply. PERIOD TO: 40374 ARCHITECT'S PROJECT NO:7715/2010 A B C O L F G U I WORK COMPLETED MATERIALS TOTAL BALANCE hROM PREVIOUS PRESENTLY COMPLETED RETAINACE c SCHEDULED ,.; 'PO ITEM DESCRIPTION OF WORK STORED AND STORED HE'VARIABLE NO. VALVE APPLICATION THISPERIOD NOT IN 'I'O DATE (0=CI FINISH RATE) D+Ea I)OR EI (D+E+F) c-c> CON HALL DOME LABOR 100,260,00 100.260.00 0.00 100,260.00 100% 0.00 10,026 00 CON HALL DOME MATERALL 35,000.00 35,000.00 0.00 35,000.00 .. .100% 0.00 3,500,00 CON HALL S WAI.1.LABOR 45,120.00 22,250.00 22,250.00 : 49% 22,870.00 2,225.00 CON HALL 5 WALL MATERIAL 9,500.00 5,000.00 5,00000_ 53% 4,500.00 500.00 CON HALLS DOME LABOR 45,920.00 41,100.00 4,820.00 45,920.00 . 100% 0.00 4,592.00 CON HALL S.COME MATERIAL 15,000.00 13,500.00 1,500.00 15,000.00 100% 0.00 1,500-00 N TIER LABOR 28,00000 14,000.00 0.00 14,000.00 50% 14,000,00 1,400.00 N TIER MATERIAL 6,500,00 3.250.00 0.00 3,250.00 50% 3,250.00 325.00 N ORCH LABOR 28,000.00 17,00000 17.00000 61% 11,000.00 1,700.00 N ORCH MATERIAL 6,500.00 4,000.00 4,00%00 62% 2.500.00 400.00 V., LOBE LABOR 28,800,00 9,50100 7,250.00 16,750.00 58% 12,050.00 1,675.00 W LOSE MATER.AIL 6,500.00 1,500.00 2,500,00 4,000.00 52% 2,500,00 400,00 W LOBE CELL LAIJOP 2.8,000 00 25,250.00 0.00 25,250.00 90% 2,750.00 2,525.00 W LOBE CLII.MTERAIL 6,500.00 6,500.00 0,00 6.500.00 100% 0.00 650.00 E LOBBY LABOR 28.000 00 0.00 0% 28,000.00 0.00 H LOBBY MATERIAL 7.000,00 0.00 0% 7,000.00 0.00 E LOBBY CEIL LABOR 38,800.00 19,000.00 0.00 19,000,00 49% 19,800.00 1,900.00 E LOBBY MATERIAL 9,300.00 4,650.00 0.00 4,65000 50% 4,650.00 465.00 S LOBE LABOR 4500000 7,500.00 0.00 7,500,00 17% 37,=_00,00 750.00 S LOBR MATERIAL 11,000.00 2,000.00 0.00 2,000.00 18% 9,000.00 200,00 SW ORCH LOB,STR WAL LAB 45,000.00 5,59000 9,500.00 18,000.00 38% 30.000.00 1,800.00 SW ORCH LOB,STR WAL MAT 6,700.00 1,500.00 2,500.00 4,000.00 46% 4,700.00 400%0 SE ORCI'I I.OB',STR WAL LAB 48,000.00 3,50100 7,500,00 11`00000: 23% 37,00000 1,100.00 SE ORCH LOB,STR WAL MAT 6,700.00 750.00 2,000.00 - 2,750.00 32% 5,950.00 275 00 SUR TOTAL PAGE O 049 10n nn ,47 7FC1 On 79 a20 nn - - n. ADO ,�T6 259,020.00 3.13,?J4,3414) 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 G703W-1992.Copyright®1963, 1965, 1966,1967, 1970, 1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIeDocument is protected by U.5-Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AleDocument,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,email The American Institute of Architects'legal counsel,copyright@aia.org. Fuji Document G703M 1992 Dn struct ens Continuation Sheet GENERAL INFORMATION Purpose and Related Documents_A IA Document G702, Application and Certificate for Payment,is to he used in conjunction with ALA 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 A20 I,General Conditions of the Contract for Construction_ Use of Current Documents.Prior to using any A IA Contract Document. users should consult www.aia ore ar a local AlA component to verify the most recent edition_ Reproductions.This document is a copyrighted work and may not he 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 masinlum of ten copies of a completed 0703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction attuned above,except upon written request and receipt of written permission from tam AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement(F.ULA).To report copyright violations of MA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyrighaaia.org. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar information on ALA Document 0702,Application and Certificate for Payment. Columns A, B&C.These columns should he 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 subseyucutly 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 he 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 adjustor 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 he entered in this column,_ Column E.Enter here the value of Work completed at the time of this application,including the value ollnaterials incorporated in the project that were listed on the previous application under Materials Presently Stored(column h). Cntumn F. Enter here the value of Materials Presenty 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 F(Work Completed—This Period.) Column C.Enter here the total of columns D, E and F.Calculate lire percentage completed by dividing column G by column C. Column H.Enter here the difference between colunin C(Scheduled Value)and column G (Total Completed and Stored to Date). Column 1.This column is normally used only for contracts where variable retainage is permitted on a lino-item basis. It need not he completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could he incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally dune.Usually.Change Orders are listed separately.either on their own 6703 form or at the end of the basic schedule. The.amount of are original contract adjusted by Change Orders is to be entered in the appropriate location on the 6702 Emit_ 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 dean with aecorcling to Section 7.3 in A20I. The flillotring is ire toample ola CiralillUrdiOn 57awr/01'nest"io progress.Please note than dollar renwrnls thrnnn helmv trreJar iilacrratirc pirrpnl'th rrnTr,and arc sot dntmrdul rrs reffect twain!conrrna hoe euoh. A u r u tl n II II I WOW I tAIPrrTEU h 1111Vti ruler 1.11A1 srrrFnrri Fri IA IIILL'101nc IN] INCnY USI LI', 1 In ISII RI WAGE 1, {MS('.µ1111-M1111'11'1],0,0 \'AI.LIT 1111,011,1.\ TIIIF PERIOD l Ilan Jan SIf NLI) I,, [ rltill ar tall nil l' n1-11 IlIml'Iri 'IUI iE, w.„1 RAI ht )llli rl IU,EI ri 1 MORTLIZAUON 5,000 5000 0 Storm 100 0 sluMP REMOVAL 5,000 5.000 9 5,000 100 0 3 EARTH WORK 15,000 10,09 5,000 i5,000 100 0 4 LOWER RETAINIros WALL 10,000 5,100 5,000 50 5000 5 CURBS 6 M$;C,CONC. 5.000 0 0 C 5,000 6 PAVIM6.UPPER DRIVE 20,000 0 0 0 20000 7 PAVING,LOWER DRIVE 20,000 0 0 C 20000 PAVERS 20.000 0 I0,00 10090 50 10,000 9 BRICK WORK ti000 0 0 0 5.000 n0 u 105,000 20000 10,000 10.000 40.000 65000 I A1A Document G703°'—1992.Copyright©1963, 1965,1966, 1967.1970, 1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIAe 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 at AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org, t =ATT AA. lit Document G703TM am. 1992 Continuation Sheet page 3 . AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor'~signed ecriineatirin is attached. APPLICATION DATE: 9 In tabulations below, amounts are stated to the nearest dollar_ 40374 Use Column I on Contracts where variable retainage Cot line items may apply. PERIOD TO: ARCHITECTS PROJECT NO:7115x3019 A B C 0 E I+ G H I WORK COMPLETED MATERIALS TO I'AL BALANCE FROM PREVIOUS PRESENTLY COMPLETED RETAINAGE SCHEDULED % TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE. VAT A UE- APPLICATION THIS PERIOD , (C+C) FINISH NO, (NOT In TO DATE RATE) (V+E) DOR E) (1)+E+17) EAT EAL L/Ii LABOR 28,000,00 14,000.00 0.00 14,000 CO 50% 14,000.00 1,400.00 BALL/II MATERIEL 6,800.00 3,40000 0.00 3,400.00 50% 3A00.00 340.00 INT CON ATTIC LABOR 17,000.00 17,000.00 0.00 17,000 00 100% 0.00 1,700.DO !NT CON ATTIC MATERIAL 3,500.00 2,500.00 0.00 3,500.00 100% 0.00 350.00 8 09-97-23; STAINS, SEALERS BASEMENT Labor' 7,700.00 5,500.00 0.00 5,500.00: 7i% 2,200.00 550.00 BASEMENT Material 5,800.00 5.500.00 0.00 5,500.00 95% 300.00 550.00 BASE MECFI.I2M LABOR 2,500.00 1,250.00 0.00 ;1,250.00 50% 1,250.00 125.00 BASE MECH RM MATER 1,500.00 750.00 0.00 :. 750.00 50% 750.00 75.047 PLEM LABOR 2.500.00 1,250.00 0.00 1,250.00 50% 1,250,00 125.00 PLEM MATERAIL 1,500.00 750.00 0.00 750.00 50% 750,00 75.00 CON HALL BALCONY LAB 4,500.00 0.00 0% 4,500.00 0.00 CON HALL BALCONY MAT 1,500.00 0.00 0% 1,500.00 0.00 ORCH LOB, STR LAB 7,500.00 0.00 0% 7,500.00 0.00 ORCH LOB, STR MAT 3,000.00 0.00 0% 3,000.00 0.00 9 DAILY CLEAN UP 15,000.00 1,500.00 3,000.00 - 4,500.00 30% 10,500.00 450.00 10 GENERAL ALLOWANCE 100,000.00 50,00300 24.318.96 74,416.96 74% 25,581.04 7441.90 I I SUPPLIES ALLOWANCE 15,000.00 2,000.00 2,000.00 13% 13,000.00 200-00 12 LABOR ALLOWANCE 75,000,00 9,500.00 9,500.00 13% 65,500-00 950.00 13 CAD ALLOWANCE 5,000.00 5,000.00 0.00 5,000.00 100% 0.00 50000 14 PROGRESS MEETINGS 5,200,00 1,850.00 750.00 2,500.00 50% 2,600.00 260.00 05 CLOSEOUTS 3,450 00 0,00 - . 0% - 3.450 00 0.00 CO 1 DEC ALLOWANCE -55000.00 -55,000.00 0.00 -55,000.00 ' 0:100% 0.00 -5,50000 CO 2 _ 0.00 0.00 • ' 0% 0.00 D.00 CO 3 -550.00 -550.00 0.00 -550.00 100% 000 -55.00 SIBTOTAL PACE 25fi 400.00 55,700.00 39,668.95 0.00 95,368.9E 9.47 161,031 04 9,536.90 SUB TOTAL PAGE 1 1.145,950.00 255,010.00 173,020.00 181.500.00 609,53000 1621 535.420 00 60,95300 - Stna TDTe,L P GF o _6 ' ."..00 90.820,00 0.00 383.300.00 13-86 200,020 AO 387309:00- ._ ..,,.... _ - 'GRAND TOTAL 2.044 450.00 607 970 00 ?9u'70P.06 i ei s'bn 00 i.0c2_928-9-6 38 7' 055,47_t..t)4 0P, 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 G703mM-1992.Copyright 0 1963,1965, 1966, 1967,1970,1978, 1983 and 1992 by The American Institute at Architects.All rights reserved.WARNING:This AteDocument Is protected by 0.5.Copyright Law and International Trestles.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-mailThe American Institute of Architects'legal counsel,copyright @aiaorgg Document Gl03rM- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AlA 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 arc 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 wwsv_aia.orti or a local AIA component to verity the most recent edition. Reproductions.This document is a copyrighted work and may not he reproduced or excerpted from without the express written permission of the ALA.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 ma:11mmn of trot copies of a completed G703,but only tiw use in connection with a particular project,The AEA 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 ALA software.Licensed AIA software users should consult the End User License Agreement(IiUt.A).'t it report copyright violations of ALA Contract Documents.e-mail The American Institute ofArchitects'legal counsel,copyright(i?aia.org. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar i nlilrnlation On AIA Document G702,Application and Certificate for Payment. Columns A,B&C.These columns should he 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 he by sections of the Work or by Subcontractors and should remain consistent throughout the Project, Multiple pages should he 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.linter in this column the amount of completed Work covered by the previous application(columns D&F from the previous application). Values from column F(Materials Presently Stored) from the previous application should nor he 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 P)_ Column F.Enter here the value of Materials Presently Stored fur which payment is sought.The total of the column in ust he recalculated at the cud 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 ti (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 mw'utage is permitted on a line-item basis. It need not he completed on projects where a constant relainage is withheld from Ile 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 0703 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 torn_ Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should he incorporated into one or inure Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A20I. 7hefh/Irlwing[char nvoinple q/a Cunliruruliun Sheufn'work in prn,trevt'.Meuse rote thou dollar unmans slain beton,arc fin.ilhubvtire pnposci unit',(Mil are Hot?moth('to Pilled ncotal L'O'LJrt'llr:nos COVO A a e II G P I I I WORK rOalP1.1'llIn 81/01.918171 tar ry II IN SCHEDULED VR01 PRIARCl;l Ir.TI.Y r.�l\1fLrlll CS .,rh II Nu IIA Mll'l 0\(Ir 1l LlllV: 1lILE IINI'.I Ill'.[ 111! HI.11L}. Alll ICA rION TIIL 1'EA1lln Ir IV 'In 'r'l IRANH "Al" IU RI LIMF] NHIH1 IU-GI E MOBILTZATION 5.000 5,000 5.000 1 0 0 2 SIVMP REMOVAL 5000 5000 5.000 1 0 0 3 EARTH WORK 12,000 10,00 5.00 1 000 1 0 0 4 LOWER RETAINING WALL 10,000 9,000 5,000 0 5,000 5 CURBS d MISC.CONC. 5,000 0 6,600 6 PAVING.UPPER oREVE 20,000 0 20000 7 PAVING,I OWE4 tRIVE 20,000 0 20,000 8 PAVERS 80.000 r 19900 10,000 5 10000 9 BRICK WORK 5,000 r 0 5,000 w ll 105,000 20000 10000 10,000 40,000 55-000 AlA Document G703111–1992.Copyright C11963.1965, 1966,1957, 1970,1978. 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlAe ngcument 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 len OM copies of this document when completed.To repot copyright violations of AIA Contract Documents.e-mail The American Institute of Architects'legal counsel,copyright@aia.org. I . D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment it 6 STATE: INDIANA FINAL XX PARTIAL PAYMENT TO FOLLOW COUNTY OF: MARION _kevin M. Blume_ Being duly sworn that he is the Secretary of Diversified Painting Co. Inc being in Jr contract with Carmel 1:edevelopn itreL Cornrnissicm to furnish certain materials and/or labor as follows. Painting & Walicovering for a project known as: Paine!7A; Regional Psfnrming Arts Center located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor /supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of ONE HUNDRED FORTY-ONE THOUSAND NINE HUNDRED THIRTY-NINE AND 00.100.-- DOLLARS: S 141,939.00 XXXX receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (FINAL WAIVER) That there is due from the contractor the sum of : DOLLARS: S - receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, in any, and further certified that no other party has any claim or right to lien on account of any work performed or moterial furnished to undersigned for said project and within the scope of this affidavit and wa er. _Diversified Painting Co. Inc. By: i President Kevvn .lurne WITNESS MY HAND AND NOTARIKI- SEAL THIS: 06/15/10 i MY COMMISSION EXPIRES: 11-08-2017 COUNTY OF RESIDENCE: Boone "�IA NOTARY Thomas E. Hill J. Thomas E. Hill O Notary Public State of Indiana'' Boone County Expires Nov 8,2017 •