BROADY-CAMPBELL, INC. - 1208 - 152,142.66 - 9/16/2010 e. ( I/J LS. or; J■_ II It/ ir, 1 I((
Application and Certificate for Payment '!t III JUL 3 o zoo i�I1
3)4;, I
TO OWNER: REI PROJECT: VILLAGE ON THE GREEN ELI) APPLICATION NO: 5 Distribution to:
COST# RED 11711 N PENNSYLVANIA PERIOD TO: 07/26/2010 OWNER
STREET SUITE 200
09-123
CARMEL IN 46032 CONTRACT FOR: ARCHITECT
FROM CONTRACTOR: •BROADT--AMPBECt, NC. VIA ARCHITECT: CONTRACT DATE: 11/17/2009 CONTRACTOR
21 I S Dr.A Brown Ave. PEDCOR DESIGN GROUT'
PROJECT NOS: FIELD
Indianapolis,IN 46202
VILLAGE ON THE GREEN BLD JOB# 29080 OTHER
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge. informntiun
Application is made for payment, as shown below, in connection with the Contract and belief the Work covered by this Application for Payment has been completed in accordance
Continuation Sheet. is attached, with the Contract Documents, that all amounts have been paid by the Contractor for Work ha
818,620.00 which previous Certificates for Payment were issued and payments received from the Owner, and
1. ORIGINAL CONTRACT SUM $ that current payment shown herein is now due.
u.00
2. Net change by Change Orders $ CONTRACTOR: Broady—Campbell, Inc.
818.620.00 Al� 7-26-2010
3. CONTRACT SUM TO DATE (Line 1 ±2) $ --
487,577.00 By:_Th 1 w-� Date:
4.TOTAL COMPLETED & STORED TO DATE (Column C on 603LS1).... $ State of: Indiana
5. RETAINAGE: County of: Marion
10.00
a. %of Completed Work 35,661 42 Subscribed and sworn to before
(Men D+ Eon 603LS1) $ me this 26th day of July 2010
b._%of Stored Material
13.096.25 �p ��� �
(Column F on 603LS 1) $ Notary Public: — rbn_ �e
48.757.70 My Commission expires: 5-5-2016
Total Retainage(Lines 5a.t. 513 or Total in Column I of 603LS 1) ... $
6. TOTAL EARNED LESS RETAINAGE $ 438,819.30 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 Less Line 5 Total) In accordance with the Contract Documents. based on on-site observations and the data comp)king
286,67664 this application, the Architect certifies to the Owner that to the best of the Architect's knowledge.
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ information and belief the Work has progressed as indicated, the quality of the Work is in
(Line 6 from prior Certificate) accordance with the Contract Documents. and the Contractor is entitled to pas Inert of the
8. CURRENT PAYMENT DUE $ 1'2,1422.66 AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED 5 1S2-I'12. 66
379.800.70
(Litre 3 less Line 6) 5 (Attach explanation 1/amount certified rlilli'rav frenn the amount app tiff'. Initial all li,nrvs era this
Application and on the Continuation+Sheet that an,changed tot myth no with the amnion t 01'g/in'
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHtTFih:G-•--
Total changes approved in previous months by Owner $ u.uu $ UM .,,,, i S%',`6
Hy: -v1-ir U:;tr:.G—�_.—.—_.
Total approved this Month $ D.uu $ —0'pU - -- --
u.uU 0.00 This Certificate is not negotiable. The AMOUNT CERTIFI EU is payable only r, the Contractor
TOl'AI.S $ S
0:00 named herein Issuance. payment and acceptance of payment ment are without prejudice to any rights of
NET CHANCES by Change Order $ the Owner or Contractor under this Contract.
REORDER FORM NO.604LS1 SEP 1 1 2010 rZ OC/�o 7iCe
P A I D SEP NyGU9 N
Continuation Sheet AIA Document G703-1992 (Instructions on reverse side.) Pace I of I
AIA Document G702, APPLICATION AND CERTTICATE FOR PAYMENT, APPLICATION NO.: 5
containing Contractor's signed Certification, is attached, APPLICATION DATE: 07/26/2010
In tabulations below, amounts ale stated to the nearest dollar.
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 07/26/2010
ARCHITECT'S PROJECT NO: 09-123
A B C D E F - C H I
WORK COMPLE I ED
MATERIALS TOTAL BAI.WCE
ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY, COMPLETED % RETMNAGE
FROM PR
F,vI0U5 TO
NO. VALUE STORED AND STORED (G ' C) (IF VARIABLE)
APPLICATION THIS PERIOD (NOT IN TO DATE FINISH RATE)
CD + E) D OR E) (D+E+F) (C G)
01 GENERAL CONDITIONS 34,300.00 8,575.00 5,145.00 13.720.00 40.00 20,580.00 1,372.00
02 BRICK LABOR 103,200.00 22,704.00 22.704.00 22.00 80.496.00 7,270.40
03 BRICK MATERIAL 75.140.00 16,530 80 24.044.80 40.575.60 54.00 34.564.40 4,057.56
04 STONE LABOR 133.370,00 36,009.90 36,009.90 2700 97,360.10 3,600.99
05 STONE MATERIAL 155.800.00 42,066.00 54,530,00 96,596.00 62.00 59,204.00 9,659.60
06 BLOCK LABOR 111.050.00 99,945.00 3.331.50 103,276.50 93.00 7.773.50 10,327.65
07 BLOCK MATERIAL 62,000.00 55,800.00 1.860.00 4.340.00 62,000.00 100.00 6,200.00
08 GRANITE LABOR 38.300.00 3.064.00 14,171.00 17235.00 45.00 21,065.00 1.723.50
09 GRANITE MATERIAL 87,360.00 6,988.80 32.323.20 48.048.00 87.360.00 100.00 8.736.00
10 BOND 8,100.00 8,100.00 8,100.00 100.00 810.00
11 ALLOWANCE 10,000,00 10.000.00
JOB TOTALS : 818,620.00 182,472.80 174,141.40 130,962.80 487,577.00 331,043 00 48.757.70
INVOICE ® CAMPBELL, ®y
BROADY- INC.
I® a MASONRY CONTRACTORS
2115 ANDREW J. BROWN AVE. • INDIANAPOLIS. INDIANA 46202 21369
ph. (317) 925-4261 fax (317) 925-4263
REI G - - Date 7-26-2010
11711 N. Pennsylvania St. � [� I r pi I, X11
TO: Suite 200 t '• II !; Job No. 29080
Carmel, IN 46032 1 JUL 3 0 2010 1;; p
IL LI :i P.O. No.
RE: Village on the Green Blvd.
ESTIMATE NO: 5
Labor, material, equipment and accessory appurtenances in
place or stored to date at the above referenced project:
487,577.00
Less 10 % retained 48,757.70
Total earned less retainer 438,819.30
Less Previous applications 286,676.64
- - • TOTAL DUE THIS ESTIMATE NO: 5 152,142.66