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HAGERMAN CONSTRUCTION CORPORATION - 1029 - 759.46 - 8/2/2010 ( r� • ' IA- =A Document G702/CMaT" — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition - TO OWNER: PROJECT:CCC—Energy Center Parcel 7C APPLICATION NO: 18 Distribution to: Cannel Redevelopment Commission HCC Job #2555 City of Cannel Invoice #9805 PERIOD .31/10 OWNER El Cannel, IN 46032 CONSTRUCTION MANAGER ❑ --3. FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Hagerman Construction Corporation P.O. Box 10690 Shied Sexton PROJECT NOS: / / CONTRACTOR ❑ 2805 Fort Wayne, IN 46853 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: CSO Architects - ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors •knowledge, information and Application is made for payment.as shown below. in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet.AIA Document 6703,is attached. 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 1.ORIGINAL CONTRACT SUM $ 1,138,000.00 payment shown herein is now due. agerman Construction Corporation 2.Net change by Change Orders $ 299,839.00 CONTRACT° • �,, 3.CONTRACT SUM TO DATE(Line I ±2) S 1,437,839.00 By: Dine: Q 10 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 1,437,839.00 •State o• Indiana e , o er . LGO $S7�,�.jJ._; . *. ember L• c, ' 5.RETAINAGE: County of: Allen ' �'4, Ayr.-->.;�G� ;�' a. %of Completed Work Subscribed and sworn to before •C• 1/�/' —m.•'• (Column D+E on G703) S 8,555.14 me this 28t• of Mai, !t+� ,� '1'71; IVOr - u+rn•. b. %of Stored Material Notary Publ �. /% 0 2• .r //Y,p * . (Column Fon G703) .g' q S My Commission expires: 12 • 15 -o,':"QygM i°%+M Total Retainage(Lines Sa+Sh or Total in Column I of G703).. S 8,555.14 CERTIFICATE FOR PAYMENT 7',-.BTATEc '\"�0.:'. 1,429,283.86 In accordance with the Contract Documents. based on on-site observations'3iiifllie data comprising 6.TOTAL EARNED LESS RETAINAGE $ 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 $ 1,428,524.40 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. �i 8.CURRENT PAYMENT DUE $ 759.46 AMOUNT CERTIFIED $ --1S21 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial all figures rat this Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 8,555.14 CONSTRUCTION-MANAGER: By: x,77. L. Date: 6/020/0 ADDITIONS DEDUCTIONS / r 110 CfiANGE ORDER SUMMARY ARCHITECT: �Total chances approved in previous months by Owner 5304,804.01S 3,375.00 0y: a Date: 6I I Total approved this Month $ _D_ S 1,590.60 This Certificate is no riniable. The AMOUNT CERTIFIED is payable only to the Contractor - TOTALS $304,804.005 4,965.00 named herein. .utne- payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $299,839.00 the Owner or ontra- or under this Contract. PAW AUG - 4 mu -_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 G7021CMaiIS—1992.Copyright ©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 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 den(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. '"-- CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00018 containing Contractors signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 072555A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLE'T'ED a TO 1F VARIABLE) STORED AND STORED ARLABLE) NO. VALUE APPLICATION THIS PERIOD FINISH RATE (NOT IN TO DATE (G-C) (C-G) (0 4.E) D OR E) (D+E+F) 0000010 GENERAL CONDITIONS 0000020 Bond $10,000.00 510,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000030 General Conditions $11,50000 511,500.00 $0.00 $0.00 511,500.00 100.000 $0.00 $0.00 0000040 Mobilization $2,500.00 $2,500.00 $0.00 $0.00 $2,500.00 100.000 S0.00 $0.00 0000050 Supervison/Engineering $40,000.00 $40,000.00 $0.00 $0.00 $40,000.00 100.000 $0.00 $0.00 0000060 Cleanup Allowance $18,000.00 $15,660.00 $2,340.00 $0.00 $18,000.00 100.000 $0.00 $0.00 0000070 Dumpsters $10,000.00 510,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000080 Toilets $3,500.00 $3,500.00 $0.00 $0.00 $3.500.00 100.000 $0.00 $0.00 0000090 Owner Allowance $3,000.00 53,000.00 $0.00 $0.00 $3,000.00 100.000 $0.00 $0.00 0000100 Subtotal General Conditions $98,500.00 $96,160.00 $2,340.00 $0.00 $98,500.00 100.000 $0.00 $0.00 0000120 EARTHWORK 0000130 Excavation/Backfill $256,000.00 $256,000.00 $0.00 $0.00 $256,000.00 100.000 $0.00 $0.00 0000140 Subtotal Earthwork $256,000.00 $256,000.00 $0.00 $0.00 $256,000.00 100.000 $0.00 $0.00 0000160 CONCRETE 0000170 Pile Caps Labor $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.000 $0.00 $0.00 0000180 Pile Caps Material $16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 100.000 $0.00 $0.00 0000190 Foundations Labor $26,000.00 $26,000.00 $0.00 $0.00 $26,000.00 100.000 $0.00 $0.00 0000200 Foundations Material $14,000.00 $14,000.00 $0.00 $0.00 $14,000.00 100.000 $000 $0.00 0000210 Pit Labor $10,000.00 $10,000.00 $0.00 $0.00 510,000.00 100.000 $0.00 $0.00 0000220 Pit Material $11,000.00 $11,000.00 $0.00 $0.00 $11,000.00 100.000 $0.00 5000 0000230 Slab on Grade Labor $13,000.00 $13,000.00 $0.00 $0.00 $13,000.00 100.000 $0.00 $0.00 0000240 Slab on Grade Material $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.000 $0.00 $0.00 0000250 Elevated Slabs Labor $4,000.00 54,000.00 $0.00 $0.00 $4,000.00 100.000 $0.00 $0.00 0000260 Elevated Slabs Material $9,000.00 $9,000.00 $0.00 $0.00 S9,000.00 100.000 $0.00 $0.00 0000270 Tunnel Base Labor $29,000.00 $29,000.00 $0.00 $0.00 529,000.00 100.000 SO 00 $0.00 0000280 Tunnel Base Material $41,000.00 $41,000.00 $0.00 $0.00 541,000.00 100.000 50.00 $0.00 0000290 Tunnel Walls Labor $92,000.00 $92,000.00 $0.00 $0.00 $92,000.00 100.000 $0.00 $0.00 0000300 Tunnel Walls Material 557,000.00 $57,000.00 $0.00 $0.00 $57,000.00 100.000 50.00 $0.00 0000310 Tunnel Top Labor 541,000.00 541,000.00 $0.00 $0.00 $41,000.00 100.000 $0.00 $0.00 0000320 Tunnel Top Material $38,000.00 $38,000.00 $0.00 $0.00 $38,000.00 100.000 50.00 $0.00 0000330 Rebar Labor $52,000.00 552,000.00 $0.00 $0.00 $52,000.00 100.000 50.00 $0.00 0000340 Rebar Material $75,000.00 $75,000.00 $0.00 $0.00 $75,000.00 100.000 $0.00 $0.00 AIA DOCUMENT G703• APPLICATION AND CERI'IFICATE FOR PAYMENT • 1992 EDIT ION • AIAte• 01992 • HIE AMERICAN INST I 1 U E OF ARCHITECT S.1735 NEW YORK G703-1992 AVENUE.N.W..WASHINGTON.D 211006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'TIt Wymert lus been lepecaccci eloctronal'y'^N the pe,m5N'n el Ins Amn an InslWle 01 Pit ee'ls,ndm Loan°9700310 M nave-a 5)Xents.Inc Rep:CUC] ,el Nn document.0,0e O,OjeCispecircnlcmvlim Is s01 ppIYpeC Cornea IN Ancuan.Insttee of ArO,JWs 10 wedN the cursed vena001mn doco.onl one k ens.slen.>. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 5 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00018 containing Contractor's signed Certification. is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 072555A - A 6 C D F F 0 H I WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED d TO VALUE SNORED AND STORED _tF VARIABLE) APPLICATION THIS PERIOD FINISH NO. V,UE RATE (NOT IN TO DATE (G-C) (C-G) (D+E) D OR El ID+E+P) 0000350 Subtotal Concrete 5558.000.00 $558,000.00 $0.00 $0.00 $558,000.00 100,000 $0.00 $0.00 0000370 GENERAL TRADES 0000380 Waterproofing $69,000.00 $69,000.00 $0.00 $0.00 $69,000.00 100.000 50.00 $0.00 0000390 Insulation $7,000.00 57,000.00 $0.00 $0.00 $7,000.00 100.000 $0.00 $0.00 0000400 Firestopping $3,000.00 53.000.00 $0.00 $0.00 $3,000.00 100.000 $0.00 $0.00 0000410 Caulking $3,000.00 $3,000.00 $0.00 $0.00 $3,000.00 100.000 $0.00 $0.00 0000420 Doors Labor $4,000.00 $4,000.00 50.00 $0.00 $4,000.00 100.000 $0.00 $0.00 0000430 Doors!Hardware Material 521,000.00 $21,000.00 $0.00 $0.00 $21,000.00 100.000 S0,00 $0.00 0000440 Glazing $500.00 $500.00 $0.00 $0.00 $500.00 100.000 $0.00 $0.00 0000450 Acoustic Ceilings $1,500.00 51,500.00 $0.00 $0.00 $1,500.00 100.000 $0.00 $0.00 0000460 Acoustic Panels Labor $14,000.00 $14,000.00 $0.00 $0.00 $14,000.00 100.000 $0.00 $0.00 0000470 Acoustic Panels Material $48,000.00 $4 8,000.00 $0.00 $0.00 $48,000.00 100.000 $0.00 50.00 0000480 Resinous Flooring $12,000.00 $12,000.00 $0.00 50.00 512,000.00 100.000 $0.00 50.00 0000490 Painting $40,000.00 $40,000.00 $0.00 $0.00 540,000.00 100.000 $0.00 50.00 0000500 Signs $2,000.00 $2,000.00 S0.00 50.00 $2,000.00 100.000 $0.00 $0.00 0000510 Toilet Accessories $500.00 $500.00 $0,00 $0.00 $500.00 100,000 $0.00 $0.00 0000520 Subtotal General Trades 5225,500.00 $225,500.00 $0.00 $0.00 $225,500.00 100.000 $0.00 50.00 0000540 CHANGE ORDER#1 0000550 PC#2-Temporary Fencing 519,195.00 519,195.00 $0.00 $0.00 $19,195.00 100.000 $0.00 $0.00 0000590 CHANGE ORDER#2 0000600 PC#01 R3-Trash Sleeves Under Tunnel $6,973.00 56,973.00 $0.00 $0.00 $6,973.00 100.000 $0.00 $0.00 0000640 CHANGE ORDER#3 0000650 PC 421R1 -Mech Tunnel Mud Slab 522,306.00 $22,306.00 $0.00 $0.00 $22,306.00 100.000 $0.00 50.00 0000670 CHANGE ORDER#4 0000680 PC#14-Dewatering 5 19,722.00 519,722.00 $0.00 $0.00 519,722.00 100,000 $0.00 $0.00 0000711 CHANGE ORDER#5 - 0000712 PC#20R1 -Dewatering $17,602.00 517,602.00 S0.00 $0.00 $17,602.00 100.000 $0.00 $0.00 AIA DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA'A• CI992 • TIIIE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK G703-1992 AVENUE:,N\W_WASHINGT ON,D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. •Ttt comment has been reproduce clues,,ally wan Na permission 01 Me American unthana o14[ntKls under Lwnw 97007 b RMVV era Systems,I,c ReprxuOnn of Mal OMimant oae.r pgecNpeo1[inbrmarcn is M mama.extinct Ma Pnancan Inn.cat,Cl PM,tecz 10 wafer We thaw?reset or en ao;rmenl and Manse status' • • - CONTINUATION SHEET AIA DOCUMENT 6703 PAGE 3or5PAGES AIA Document(.1702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00018 containing Contractor's signed Certification, is attached. APPLICATLON DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 072555A A B C D E F G H I WORK COMPLETED MATERLALS TOTAL BALANCE PRESENTLY COMPLETED RETAIL AGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS TO IF VARIABLE) VALUE S'IORBD AND STORED FINISH NO. APPLICATION THIS PERIOD INOT IN TO DATE (GEC) RATE (C-GI (D+.El D OR 8) (D+E+F) 0000720 CHANGE ORDER#6 0000730 PC#22-Bad Soils at Mech Tunnel $12,221.00 $12,221.00 $0.00 $0.00 $12,221.00 100.000 S0.00 $0.00 0000740 PC#23-Bad Soils at Mesh Tunnel $7,588.00 57,588.00 $0.00 $0.00 $7,588.00 100.000 $0.00 $0.00 0000750 Subtotal CO#6 $19,809.00 $19,809.00 $0.00 $0.00 $19,809.00 100.000 $0.00 $0.00 0000770 CHANGE ORDER#7 0000780 PC#24-Delete 2'Bump Out ($338.00) ($338.00) $0.00 $0.00 (5338.00) 100.000 $0.00 $0.00 0000800 CHANGE ORDER#8 0000810 PC#09R1 -7'Additional Tunnel(50%) $19,160.00 $19,160.00 $0.00 $0.00 519,160.00 100.000 $0.00 $0.00 0000830 CHANGE ORDER#9 0000840 PC#05R3-A -Shared East Wall at Bldg. 521,276.00 $21,276.00 $0.00 $0.00 $21,276.00 100.000 $0.00 $0.00 0000860 CHANGE ORDER#10 0000870 PC#05R3-B -Shared East Wall at Courtyard $33,581.00 $33,581.00 $0.00 $0.00 $33,581.00 100.000 $0.00 $0,00 0000890 CHANGE ORDER#11 0000900 PC#0583-C -Shared East Wall North of Cou $33,620.00 $33,620.00 $0.00 $0.00 $33,620.00 100.000 $0.00 $0.00 0000920 CHANGE ORDER#12 0000930 PC#12R1 -Additional Fencing Work $1,232.00 $1,232.00 $0.00 $0.00 $1.232.00 100.000 $0.00 $0.00 0000950 CHANGE ORDER#13 0000960 PC#16R1 -Subdrainage along Tunnel $16,920.00 $16,920.00 90.00 $0.00 $16,920.00 100.000 $0.00 $0 00 0000980 CHANGE ORDER#14 0000990 PC#25 Mechanical Pit Access Lid $2,289.00 $2,289.00 $0.00 $0.00 $2,289.00 100.000 $0.00 $0.00 0001010 CHANGE ORDER#15 0001020 PC#11R2-RFO EC 10 ESI Enlarge Mechanic $7,744.00 $7,744.00 S0.00 $0.00 87,744.00 100.000 $0.00 $0.00 - 0001040 CHANGE ORDER#16 0001050 PC#15-Delete 2'x 8'Louver ($459.00) ($459.00) $0.00 $0.00 ($459.00) 100.000 $0.00 $0.00 AIA DOCUMENT G703•APPLICATION AND CERTIPICA I'E FOR PAYMENT • 1902 EDITION • AIMS.' 61992 • 'I lir AMERICAN INSTITUTE OE ARCHITECTS,1735 NEW YORK G703-1992 AVENUE,N W..WASIIIN(I'TON,D.C. 2(0065292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. Mtn o«unaq Ras been repsWucat e4eto'kay ran aW pannsm,cl ire Ameican Indust of Art teats undo,ucnseerooa u RYna.era 5r-101111.M.Rewsura^.n a ass name •Mout om:ec'4Ralc inbmlalm is not p$Imlasa contact PP*Amarcan Instu,e R A,ctuleas 10 tents ae outran version of this coalmen and s ense status CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00018 containing Contractors signed Certification. is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 072555A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE ITEM SCHEDULED -- - PRESENTLY COMPLETED TO DESCRIPTION OF WORK FROM PREVIOUS % IF VARIABLE) NO. VALUE STORED AND STORED FINISH APPLICATION THIS PERIOD iNOT IN TO DATE (G-C) RATE (C-G) (D+E) D OR E) 1D+E+F) 0001070 CHANGE ORDER#17 0001080 PC#13R1 -Added Dowel Bar Replacement $10,476.00 $10,476.00 $0.00 $0.00 $10,476.00 100.000 $0.00 $0.00 0001100 CHANGE ORDER#18 0001105 PC#03-Truck Wash Pad $4,992.00 $4,992.00 $0.00 $0.00 $4,992.00 100.000 $0.00 $0.00 0001110 PC#2-Temporary Fencing ($216.00) ($216.00) $0.00 $0.00 ($216.00) 100.000 $0.00 $0.00 0001120 PC#3-Truck Wash Pad ($325.00) ($325.00) $0.00 $0.00 ($325.00) 100.000 $0.00 $0.00 0001130 Subtotal CO#18 $4,451.00 $4,451.00 $0.00 $0.00 $4,451.00 100.000 $0.00 $0.00 0001150 CHANGE ORDER#19 0001160 PC#30R1 -Dewatering $2,058.00 $2,058.00 $0.00 $0.00 $2,058.00 100.000 $0.00 $0.00 0001180 CHANGE ORDER#20 0001190 PC#18-Door Hardware Modifications $3,006.00 53,006.00 50.00 $0.00 $3,006.00 100.000 $0.00 $0.00 0001200 PC#31 -Concrete Door Base at Courtyard $780.00 $780.00 S0.00 $0.00 $780.00 100.000 $0.00 $0.00 0001210 Subtotal CO#20 $3,786.00 $3,786.00 $0.00 50.00 $3,786.00 100.000 $0.00 $0.00 0001230 CHANGE ORDER#21 0001240 PC#43R2-Drain Tile Modifications $24,000.00 $24,000.00 $0.00 $0.00 $24,000.00 100.000 $0.00 $0.00 0001260 CHANGE ORDER#22 0001270 PC#40-Eliminate Exterior Signage ($875.00) ($875.00) $0.00 $0.00 ($875.00) 100.000 $0.00 S0.00 0001290 CHANGE ORDER#23 0001300 PC#35R2-2 Fire Extinguisher& 1 Mirror $745.00 $745.00 $0.00 $0.00 $745.00 100.000 $0.00 $0.00 0001320 CHANGE ORDER#24 0001330 PC#17-Dewatering $732.00 $732.00 $0.00 $0.00 $732.00 100.000 $0.00 $0.00 0001340 PC#32R1 -Dewatering $8,012.00 58,012.00 $0.00 $0.00 $8,012.00 100.000 $0.00 $0.00 0001350 PC#33-Dig Well for Dewatering $1,627.00 $1,627.00 5400 $0.00 $1,627.00 100.000 50.00 $0.00 0001360 PC#38-Dewatering $3,635.00 $3,635.00 $0.00 $0.00 $3,635.00 100.000 $0.00 $0.00 0001370 PC#42-Dewatering $805.00 S805.00 $0.00 $0.00 $805.00 100.000 $0.00 $0.00 0001380 PC#45-Dewatering $2,327.00 $2,327.00 $0.00 $0.00 $2,327.00 100.000 $0.00 $0.00 AIA DOCUMENT G703-APPLICATION AND CERTIFICATE FOR PAYMENT • 199_2 EDITION • AIA&• 61992 • THE A'1ERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK G703-1992 AVENUE,N.W..WASHINGTON.D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'MIS 0econem MS been reVOSeoed ebc'jotan wtlM1 tie wtmesen of me American is to W A,[TIIMs undo License^]ro]to Orman era Systems.Inc Hoorreucan a thn dmmell MdWI ome[lopedfc ji,malion is not permit/MCI.Lama]eM American lnSr 1.M el AmnnersS '0 tents the tuoenl eodlfn 01 Ste Cosumnl end f'tense 5YW5' • CONTINUATION SHEET AIA DOCUMENT G703 PAGE5OF5PAGES AIA Document(3702.APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00018 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 072555A A B C D F F G H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED IF ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS % TO 7F VARI.ABLE) NO. VALUE STORED AND STORED FINISH APPLICATION TI IIS PERIOD (NOT TO DATE 10+-C) RATE IN (D+E) D OR E) (D+F.+F) (C G) 0001390 Subtotal CO#24 $17,138.00 $17,138.00 $0.00 $0.00 517.138.00 100.000 50.00 $0.00 0001410 CHANGE ORDER#25 0001420 PC#45-Paint Changes on Roof $1,518.00 $1,518.00 50.00 $0.00 $1,518.00 100.000 $0.00 $0.00 0001440 CHANGE ORDER#26 0001450 Eliminate Fencing at Transformer Yard ($2,500.00) ($2,500.00) $0.00 $0.00 (52,500.00) 100.000 $0.00 $0.00 0001470 CHANGE ORDER#27 0001480 Allowance Deduct ($1,590.00) $0.00 ($1,590.00) $0.00 (51,590.00) 100.000 $0.00 $0.00 $1,437,839.00 $1,437,089.00 $750.00 $0.00 $1,437,839.00 100.00% $0.00 $0.00 AIA DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AI/YR.• CI 992 • THE.AMERICAN INSrITVre OF ARCHITECTS.!735 NEW YORK G703-1992 AVENUE,N.W.WASHINGTON,D . 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'TM OeYCSni fun Deer,Poduevd c cc a calN w,m the W+mimn ce Toe Amn+T Infuwe d Arcrxeds We.Leenre 9700310 Nina, s) cros.Inc Rep,oducten of the document rnoom PAe:/.Teorc Ffrnmauian*not cm 9000.CmUicc The Ane'Nan Inrmde of Arw,ecu to venfr the current vmmn n nits mcumem and I¢nse Earns• WAIVER OF LIEN The undersigned is the duly authorized office rof o ,„ Con ration ,the generalcontractor, (Name of Company) subcontractor, materialman or other person furnishing the services, labor, material or equipment indicated below in the construction of improvements upon real estate located in Hamj lton _ County, State of Indiana , commonly known as Cannel Energy Center which rear estate is owned by Carmel Redevelopment ('Owner"). Commission INCONSIDERATIONof the sum of Seven hundred fifty nine and 46/100 DOLLARS ($ 759.46 ), receipt of which is hereby acknowledged, and in order to procure one or more payments for services, labor, material or equipment provided in such construction,the Company does hereby waive, release and quit claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which the Company may now have forservices,labor,material or equipment furnished in respect of such landorimprovements to and including the date hereof. The undersignedwarrants that the Company has not and will not assign any claimforpayment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself (herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received hereunder. The undersigned further slates that the consideration received hereunder is the sole consideration received by the Company for said services,labor,material or equipment furnished to date, and that the Company has neither received nor made any security interest,title retention interest or lien rights in the said services,labor, material or equipment other than that released and transferred hereby. The material, labor,services or equipment furnished are more particularly described in the affidavit for payment submitted of even date herewith, The undersigned further warrants and represents that the Company has compliedwith all prevailing wage requirements under applicable raw or as may be set forth in the contract documents. WITNESS the execution hereof this 28th day of May 2010 • E_ a - erne an. Title) Troy Heisl-r, Lontroll r Hagerman r'nngtruct inn rnrporntion (Name of Company) State of Indiana , County of Allen , SS: Before me, the undersigned, a Notary Public in and for said County and State, personally appeared Troy Heisler the controller , of Hagerman Construction Corporation , who acknowledged (Title) (Name of Company) the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 28th dany.:of• .. May 2019— MM •• I LEi�.�.r My Commission Expires: Oei�<ly' i� / Is f PS ,; ��. q Notary Public l AF -5 G"VOA. 0 • V SE' c,4 My County of Residence ` /Vry �.•'� *.` David C. Thomas . , ,g rte•..... ;N. .;! ..• (Printed Name of Notary Public)• Allen . #AIA Document G702/CMaim — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: - PROJECT:CCC—Energy Center Parcel 7C APPLICATION NO: 19 Distribution to: Carmel Redevelopment Commission HCC Job #2555 PERIODT0:05/31/10 OWNER ❑ City of Carmel Invoice #9806 Carmel, .IN 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Hagerman Construction Corporation ' P.O. Box 10690 Shied. Sexton PRffir5CT NOS: / I CONTRACTOR CI Fort Wayne, IN 46853 VIA ARCHITECT: HELD ❑ CONTRACT FOR: CSO Architects ❑ 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. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document 07[13,is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous - - Ccnificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $1,138,000.00 payment shown herein i.s now due. 2. Net change by Change Orders S 299,839.00 CONTRACTORHagerman Cons ruction Corporationt , is tiW0 Tv 3.CONTRACT SUM TO DATE(Line 1 ±2) 51,437,839.00 By: ��� �t.• .It"�`�2$, 2010 4.TOTAL COMPLETED&STORED TO DATE(Column 6 on G7(3) $1,437,839.00 State ot: Tn8Yanaeisler, Controller :Q fusty '•• s.. 5.RETAINAGE: Conmyof: Allen v"a" ,331 t• a. %.uf Cumplcicd Work Subscribed and sworn to before see L*z (Column D+Eon 6703) $ 0.00 me this 28 a o€ May, 1 ct N07ArYSFAL LIT b. %of Stored Material Notary Pub' : r (Column F on 6703) $ My Commission expires: 2 rr-,.- - `�"c rcn+....- Total Retaiuuee(Lines sa+sb or Total in Column I el6703).. 0.00 CERTIFICATE FOR PAYMENT :-- , . T4 "'- In accordance with the Contract Documents. based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 1,437,839.00 this application. the Construction Manager and Architect certify to the Owner that to the hest of their (Line 4 Less Line 3 Total) knowledge, information and belief the Work has progressed as indicated"'the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT S 14_422r283.86 accordance with the Contract Documents. and the Contractor is entitled to:payrncnt of the AMOUNT (Line ti from prior Certificate) CERTIFIED. ', ��rr''�� i 8.CURRENT PAYMENT DUE_ $ 8/555.44 AMOUNT CERTIFIED - `S GCS S 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if tm,ou,rr certified d ffers from the,amount applied.Initial all figures an this Application and on the Con c tration Street that are changed to conform n•itlt the ammo:certified (Line 3 less Line 6) 0.00 CONSTRUCTION MANAGER? / Hy: ../01/— Date: !o /ho/O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: 1 Total changes approveuan previous months by Owner $304,804.02 4,965.co By: Date: 1 I+" Total approved this Month $ —0— $ —0— This Ccrti-cute is 1Ore`cearee. 'fh- . _ INT CERTIFIED is payable on t the Contractgr . TOTALS $304,804.003 4,965.00 named 1 rein. I.- ante.payment and acceptance of payment arc without prejudice to any rights of NET CHANGES by Change Order $299,839.00 the Ow ter ".ontractor under this Contract. . 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 G702ICMa'°-1992.copyright ®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 AlAe Document,or any portion of tt,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers am 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. CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF 5 PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT. APPLICATION NO.: 00019 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 05/31/10 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 072555A A B C D F F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE RFTAINAGE ITEM DESCRIPTION OF WORK SCHEDULED ROM PREVIOUS PRESENTLY COMPLETED % TO IF VARIABLE) NO. VALUE STORED AND STORED FINISH APPLICATION THIS PERIOD (NOT IN TO DATE (0 C) RATE (C G) (D t E) D OR E) (D-E+F) 0000010 GENERAL CONDITIONS 0000020 Bond $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000030 General Conditions $11,500.00 $11,500.00 $0.00 $0.00 $11,500.00 100.000 $0.00 $0.00 0000040 Mobilization $2,500.00 $2,500.00 $0.00 $0.00 $2,500.00 100.000 $0.00 $0.00 0000050 Supervison/Engineering $40,000.00 $40,000.00 $0.00 $0.00 $40,000.00 100.000 $0.00 $0.00 0000060 Cleanup Allowance $18,000.00 $18,000.00 $0.00 $0.00 518,000.00 100.000 $0.00 $0.00 0000070 Dumpsters $10,000.00 $10,000.00 $0.00 $0.00 510,000.00 100.000 $0.00 $0.00 0000080 Toilets $3,500.00 $3,500.00 $0.00 $0.00 53,500.00 100.000 $0.00 $0.00 0000090 Owner Allowance 53,000.00 53,000.00 $0.00 $0.00 $3,000 00 100.000 $0.00 $0.00 0000100 Subtotal General Conditions 598,500.00 $98,500.00 $0.00 $0.00 S98,500.00 100.000 $0.00 $0.00 0000120 EARTHWORK 0000130 Excavation/Backfill $256,000.00 $256,000.00 $0.00 $0.00 $256,000.00 100.000 $0.00 $0.00 0000140 Subtotal Earthwork 5256,000.00 $256,000.00 $0.00 $0.00 $256,000.00 100.000 $0.00 S0.00 0000160 CONCRETE 0000170 Pile Caps Labor 515.000.00 515,000.00 $0.00 $0.00 $15,000.00 100.000 50.00 $0.00 0000180 Pile Caps Material $16,000.00 $16,000.00 $0.00 $0.00 516,000.00 100.000 $0.00 $0.00 0000190 Foundations Labor $26,000.00 $26,000.00 $0.00 $0.00 526,000.00 100.000 $0.00 $0.00 0000200 Foundations Material $14,000.00 $14,000.00 S000 $0.00 $14,000.00 100.000 50.00 $0.00 0000210 Pit Labor $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000220 Pit Material $11,000.00 $11,000.00 $0.00 $0.00 $11,000.00 100.000 $0.00 $0.00 0000230 Slab on Grade Labor $13,000.00 513,000.00 $0.00 $0.00 $13,000.00 100.000 $0.00 $0.00 0000240 Slab on Grade Material $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.000 $0.00 $0.00 0000250 Elevated Slabs Labor $4,000.00 54,000.00 $0.00 $000 $4,000 00 100.000 $0.00 $0.00 0000260 Elevated Slabs Material $9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100.000 $0.00 $0.00 0000270 Tunnel Base Labor $29,000.00 $29,000.00 $0.00 50.00 $29,000.00 100.000 $0.00 $0.00 0000280 Tunnel Base Material $41,000.00 $41,000.00 $0.00 $0.00 541,000.00 100.000 $0.00 $0.00 0000290 Tunnel Walls Labor $92,000.00 $92,000.00 50.00 $0.00 $92,000.00 100.000 $0.00 $0.00 0000300 Tunnel Walls Material $57,000.00 $57,000.00 $0.00 $0.00 $57,000.00 100.000 $0.00 $0.00 0000310 Tunnel Top Labor 541,000.00 $41,000.00 50.00 50.00 $41,000.00 100.000 $0.00 $0.00 0000320 Tunnel Top Material $38,000.00 $38,000.00 $0.00 $0.00 $38,000.00 100.000 $0.00 $0.00 0000330 Rebar Labor 552,000.00 $52,000.00 $0.00 $0.00 $52,000.00 100.000 $0.00 $0.00 0000340 Rebar Material $75,000.00 $75,000.00 $0.00 $0.00 $75,000.00 100.000 $0.00 $0.00 AIA DOCUMENT G703• ,AIPLICA'I'ION AND CERTIFICATE FOR PAYMENT • 1992 F.1)I'1ION • AJAR• 01992 • THF,AMERICAN INSTITUTE OFARCIIITEC5.1735 NEW YORK G703-1992 AVENUE.N.Y,..WASIIINGTON.D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'Ms occurrent has Wen'ovccMwctlu7eaa:ny won toop<^^aron of The Am,-ncan Institute aN'_t,nuos urger License 97003 to Vnmaaece systems.Inc aepoeanen on Nrs document wmmut:rciechspd(c information IS not Gemloac.C.m6-The Ame,uin lnsttae Cl•rctnew 10 torts mo cured version or nis,mmen,and trense status' • CONTINUATION SHEET A1A DOCUMENT G703 PAGE 2 OF 5 PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00019 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 05/31/10 Use Column Ion Contracts where variable retainaec for line items may apply. ARCHITECT'S PROJECT NO.: 072555A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED 10 RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS ,1 IF VARIABLE) NO. VALUE STORIED AND STORED FINISH APPLICATION THIS PERIOD (NOT IN TO DATE (G=C) RATE (D+E) D OR El (D+E+F) (C-G) 0000350 Subtotal Concrete $558.000.00 $558,000.00 $0.00 $0.00 $558,000.00 100.000 $0.00 $0.00 0000370 GENERAL TRADES 0000380 Waterproofing $69,000.00 569,000.00 $0.00 $0.00 $69,000.00 100.000 $0.00 $0.00 0000390 Insulation $7,000.00 $7,000.00 $0.00 $0.00 $7,000.00 100.000 $0.00 $0.00 0000400 Firestopping $3,000.00 $3,000.00 $0.00 $0.00 $3,000.00 100.000 $0.00 $0.00 0000410 Caulking $3,000.00 $3,000.00 $0.00 $0.00 $3,000.00 100.000 $0.00 $0.00 0000420 Doors Labor $4,000.00 $4,000.00 $0.00 $0.00 $4,000.00 100.000 $0.00 $0.00 0000430 Doors/Hardware Material $21,000.00 $21,000.00 $0.00 $0.00 $21.000:00 100.000 $0.00 $0.00 0000440 Glazing $500.00 $500.00 $0.00 $0.00 $500.00 100.000 $0.00 $0.00 0000450 Acoustic Ceilings $1,500.00 $1,500.00 $0.00 $0.00 $1,500.00 100.000 $0.00 $0.00 0000460 Acoustic Panels Labor $14,000.00 $14,000.00 $0.00 $0.00 $14,000.00 100.000 $0.00 $0.00 0000470 Acoustic Panels Material $48,000.00 $48,000.00 $0.00 $0.00 $48,000.00 100.000 $0.00 $0.00 0000480 Resinous Flooring 512,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100.000 $0.00 $0.00 0000490 Painting $40,000.00 $40,000.00 $0.00 $0.00 $40,000.00 100.000 $0.00 $0.00 0000500 Signs $2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100.000 $0.00 50.00 0000510 Toilet Accessories $500.00 $500.00 $0.00 $0.00 $500.00 100.000 $0.00 $0.00 0000520 Subtotal General Trades $225,500.00 $225,500.00 $0.00 $0.00 $225,500.00 100.000 $0.00 $0.00 0000540 CHANGE ORDER#1 0000550 PC#2-Temporary Fencing $19,195.00 $19,195.00 $0.00 $0.00 $19,195.00 100.000 $0.00 50.00 0000590 CHANGE ORDER#2 0000600 PC#01R3-Trash Sleeves Under Tunnel $6,973.00 $6,973.00 $0.00 $0.00 $6,973.00 100.000 $0.00 50.00 0000640 CHANGE ORDER#3 0000650 PC#21R1 -Mech Tunnel Mud Slab $22,306.00 $22,306.00 $0.00 $0.00 $22,306.00 100.000 $0.00 $0.00 0000670 CHANGE ORDER#4 0000680 PC#14-Dewatering $19,722.00 $19,722.00 $0.00 $0.00 $19,722.00 100.000 50.00 $0.00 0000711 CHANGE ORDER#5 • 0000712 PC#20R1 -Dewatering $17,602.00 $17,602.00 $0.00 $0.00 $17,602.00 100.000 $0.00 $0.00 AIA DOCUMENT G703-APPLICATION AND CERTIFICAI'EFOR PAYMENT • 1992 EDITION • AIAM)• C1992 • THEAMtIRICAN INSTITUTE OF ARCIIITECTS,1735 NEW YORK G703-1992 AVENUE.N.W_WASHINGTON,DC. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'This d,Odme:l has been re„odv[ed oetLm.[erll x^..n The pemrsson of It,.Amen,Insllole el FrtRtats rodo'Lcenso 97X3 m G:--TUera Systems,Inc.Repr44ucrni el no a«u enl+Mwt YNeaspedne lnro,na4m Is be rem-cea,COnan The A noncan InsWle of Ambles to sedro the cu,,.-en venan c.vas mcument aril license start,:.' ' CONTINUATION SHEET ALA DOCUMENT G703 PAGE 3 of 5 PAGES AEA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00019 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 05/31/10 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 072555A A B C D E F O H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAMAG F: I I EM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS % l0 IF VARIABLE) NO. VALUE APPLICATION THIS PERIOD STORED AND STORED FINISH RATE (NOT IN TO DATE (G-C (C-G) (D 4 E) D OR El (D+E+F) 0000720 CHANGE ORDER#6 0000730 PC#22-Bad Soils at Mech Tunnel 512,221.00 512,221.00 50.00 $0.00 $12,221.00 100.000 $0.00 $0.00 0000740 PC#23-Bad Soils at Mech Tunnel $7,588.00 57,588.00 $0.00 $0.00 $7,588.00 100.000 $0.00 $0.00 0000750 Subtotal CO#6 519,809.00 $19,809.00 S0.00 $0.00 $19,809.00 100.000 $0.00 $0.00 0000770 CHANGE ORDER#7 0000780 PC#24-Delete 2'Bump Out ($338.00) ($338.00) 50.00 50.00 ($338.00) 100.000 50.00 $0.00 0000800 CHANGE ORDER#8 _ 0000810 PC#09R1 -7'Additional Tunnel(50%) $19,160.00 $19,160.00 50.00 $0.00 519,160.00 100.000 $0.00 $0.00 0000830 CHANGE ORDER#9 0000 840 PC#05R3-A -Shared East Wall at Bldg. $21,276.00 $21,276.00 $0 00 $0.00 521,276.00 100.000 50.00 $0.00 0000860 CHANGE ORDER#10 0000870 PC#05R3-B -Shared East Wall at Courtyard 533,581.00 533,581.00 $0.00 $0.00 $33,581.00 100.000 50.00 50.00 0000890 CHANGE ORDER#11 0000900 PC#05R3-C -Shared East Wall North of Coo 533,620.00 533,620.00 50.00 $0.00 533,620.00 100.000 50.00 50.00 0000920 CHANGE ORDER#12 0000930 PC#12R1 -Additional Fencing Work $1,232.00 $1,232.00 50.00 $0.00 51,232.00 100.000 5000 $0.00 0000950 CHANGE ORDER#13 0000960 PC#16R1 -Subdrainage along Tunnel 516,920.00 516,920.00 50.00 $0.00 $16,920.00 100.000 50.00 $0.00 0000980 CHANGE ORDER#14 0000990 PC#25 Mechanical Pit Access Lid $2,289.00 $2,289.00 $0.00 50.00 52,289.00 100.000 50.00 $0.00 0001010 CHANGE ORDER#15 0001020 PC#11R2-RFO EC 10 ESI Enlarge Mechanil 57,744.00 $7,744.00 $0.00 $0.00 57,744.00 100.000 $0.00 50.00 - 0001040 CHANGE ORDER#16 0001050 PC#15-Delete 2'x 8'Louver ($459.00) ($459.00) $0.00 $0.00 ($459.00) 100.000 $0.00 $0.00 ALA DOCUMENT G703'APPLICATION ANDCERTIPICATE FOR PAYMENT • 19922 EDITION • ALAD• 01992 • 1'HE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK G703-1992 AVENUE.NAV..WASHINGTON,D.C. 2(x106-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'This dWrmanr has]an repro:u(W ebtlrdrta v will NB prmissk)r,el The Ameocar.Institute a:ArN,M]:We'Nose 97003,a Prirrawa snlome.Inc.RBIXacamrs,al ass dousnery thrthoul TOO CSOpealc mMmalm s not permitted.Cmraa The Ats roan,nsttne N Aremlfcs to verat vie Current versbn el This dm nont and Hansa Sta15 • ' • CONTINUATION SHEET AIA DOCUMENT G703 PAGE 4 or 5 PACES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00019 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:05/31/10 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 072555A A B C D L' F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED 'IF DESCRIPTION OF WORK FROM PREVIOUS %0 10 'IF VARIABLE) NO. VALUE APPLICATION THIS PERIOD STORED AND .0 FEYISII RATE (NOT IN TO DATEATE, IGEC) (C-G) (I)+E) D OR El (D+E+p-) 0001070 CHANGE ORDER#17 0001080 PC#13R1 -Added Dowel Bar Replacement $10,476.00 $10,476.00 $0.00 $0.00 $10,476.00 100.000 $0.00 $0.00 0001100 CHANGE ORDER#18 0001105 PC#03-Truck Wash Pad $4,992.00 $4,992.00 $0.00 $0.00 $4,992.00 100.000 $0.00 $0.00 0001110 PC#2-Temporary Fencing ($216.00) ($216.00) $0.00 $0.00 ($216.00) 100.000 50.00 $0.00 0001120 PC#3-Truck Wash Pad ($325.00) ($325.00) $0.00 $0.00 ($325.00) 100.000 $0.00 $0.00 0001130 Subtotal CO#18 $4,451.00 $4,451.00 $0.00 $0.00 $4,451.00 100.000 $0.00 $0.00 0001150 CHANGE ORDER#19 0001160 PC#30R1 -Dewatering $2,058.00 $2,058.00 $0.00 $0.00 $2,058.00 100.000 $0.00 $0.00 0001180 CHANGE ORDER#20 0001190 PC#18-Door Hardware Modifications $3,006.00 $3,006.00 $0.00 $0.00 $3,006.00 100.000 90.00 $0.00 0001200 PC#31 -Concrete Door Base at Courtyard $780.00 $780.00 $0.00 $0.00 5780.00 100.000 $0.00 $0.00 0001210 Subtotal CO#20 $3,786.00 $3,786.00 $0.00 $0.00 $3,786.00 100.000 $0.00 $0.00 0001230 CHANGE ORDER#21 0001240 PC#43R2-Drain Tile Modifications $24,000.00 $24,000.00 $0 00 $0.00 $24,000.00 100.000 $0.00 $0.00 0001260 CHANGE ORDER#22 0001270 PC#40-Eliminate Exterior Signage ($875.00) ($875.00) $0.00 $0.00 (5875.00) 100.000 50.00 $0.00 0001290 CHANGE ORDER#23 0001300 PC#35R2-2 Fire Extinguisher& 1 Mirror $745.00 $745.00 $0.00 $0.00 $745.00 100.000 $0.00 $0.00 0001320 CHANGE ORDER#24 0001330 PC#17-Dewatering $732 00 5732.00 $0.00 $0.00 $732.00 100.000 $0.00 50.00 0001340 PC#32R1 -Dewatering $8,012.00 $8,012.00 $0.00 $0.00 $8,012.00 100.000 $0.00 $0.00 0001350 PC#33-Dig Well for Dewatering $1,627.00 $1,627.00 $0.00 S0.00 $1,627.00 100.000 $0.00 $0.00 0001360 PC#38-Dewatering $3,635.00 $3,635.00 $0.00 $0.00 53,635.00 100.000 50.00 $0.00 • 0001370 PC#42-Dewatering $805.00 $805.00 $0.00 $0.00 $805.00 100.000 50.00 $0.00 0001380 PC#45-Dewatering 52,327.00 52,32700 $0.00 $0.00 $2,327.00 100.000 $0.00 $0.00 AIA DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT • 19922 EDfHUN • AIA*• 01997 • THE AMERICAN INSTITUTE OF ARCIIITECIS.1735 NEW YORK G703-1992 AVENUE.N.W..WASHINGT ON.D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. '1M apvnem has p.m repoJuccie oleamnically•+m me permu tm al The Amen,,Inselute m Mnu0.Ya uMOr Lmnse 07003 to RNwr..a Systems.lox. RtlpMuCtion of Mrs aocumont.nmzl pge,apear'C mN'mata,IS nni p•tmmed CatC,site Am.M-an Ion,,,e eraeutWS to uamr tw weme gEgsbzwl et meazum.m and keno s.aua. • • CONTINUATION SHEET AlA DOCUMENT G703 PAGs5OF5 PACES AIA Document 6702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO-: 00019 containing Contractors signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO, 05/31/10 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 072555A A B C D E F 0 H I WORK COMPLETED MATERIALS TOTAL HALANCE PRESENTLY COMPLETED RETAINAGE A'I DESCRIPTION 01'l4'pRK SCHEDULED FROM PREVIOUS Ss TO NO VALUE STORED AND STORED FINISH R VARIABLE) • APPLICATION THIS PERIOD (VOT EN TO DATE (G-t? RATE (C-G) (D-E) 0 OR E) (D+E+F) 0001390 Subtotal CO#24 $17,138.00 $17,138,00 $0.00 $0.00 517,138,00 100.000 50.00 $000 0001410 CHANGE ORDER#25 0001420 PC#45-Paint Changes on Roof 51,518.00 $1,518.00 $0.00 $0.00 $1,518.00 100.000 $0.00 $0.00 0001440 CHANGE ORDER 426 0001450 Eliminate Fencing at Transformer Yard ($2,500.00) ($2,500.00) $0.00 $0.00 (52.500.00) 100,000 $0.00 50.00 0001470 CHANGE ORDER#27 0001480 Allowance Deduct ($1,590,00) ($1.590.00) 50 00 50,00 ($1,590.00) 100.000 50.00 50.00 $1437,839,00 $1,437,839 00 S000 50,00 $1,437,83900 100.00% $0.00 $0.00 AIA DOCUMENT GM* APPLICATION AND CERTIFICAIT FOR PAYMENT • 1992 EDITION • AFM•• i1;1992 • IHF AMERICAN INSTITUTE OF ARCHErELLS,1735 NEWYORK G703-1992 AVENUE,N.W. WASIIINGION,Of 2&N6-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'This 0.a.umcnt toy bee,reVD4iKY chcltmnrell/with se permiFloon d ilo American Ins91,to of ArC,isis ur4o'Lito,,e 9700310 Rii ryem Sewn,,Ir,. Rtpr¢IUtlwn M Mis locumenl wi*osl prapc1.5;wnlic inlwmalron 10 M peimitod. Cpn10CI TIeD AnCrx!an InsnCNO N ArTnetit IQ verM 0M1e anent.nsion of Nis dmlmenl arol Vcnse tiaras" • WAIVER OF LIEN The undersigned is the duly authorized officer ofd,,,..,,,„„ � ,et n_c eEpora�ien—,thegeneralcontractor, (Name of Company) subcontractor, materialman or other person furnishing the services, labor, material or equipment indicated belo.v in the construction of improvements upon real estate located in Hamilton County, State of Indiana , commonly known as Carmel Energy Center , which real estate is owned by Carmel Redevelopment ("Owner"). Commission IN CONSIDERATION ofthesumofEight thousand five hundred fifty five and 14/100 DOLLARS($ 8,555.14 ), receipt of which is hereby acknowledged, and in order to procure one or more payments for services, labor, material or equipment provided in such construction, the Company does hereby waive, release and quit claim in favor of the Owner o1 the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which the Company may now have forservices,labor,material or equipmentfumished in respect of such land orimprovements to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claimforpayment nor any right to perfect a fen against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself (herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder is the sole consideration received by the Company for said services,labor, material or equipment furnished to date,and that the Company has neither received nor made any security interest,title retention interest or lien rights inthe said services,labor,material or equipment other than that released and transferred hereby. The material, labor,services or equipment furnished are more particularly described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has compliedwith all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 22th day of May , 2010_ • (N.me and Tate)Troy Heisler, Controller ilagerman C9pstnirtion CnrporaL1nn (Name of Company) State of Indiana , County of Allen . , SS: Before me, the undersigned, a Notary Public in and for said County and State,personally appeared Troy Heisler the controller , of Hagerman Construction Corporation , who acknowledged (Title) (Name of Company) the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 28th rh May , 2010 . ,.rrr ii + ^.y ldl$Sr!( ►y e My Commission Expires: 'g, ,mh®rr � , fah lal 4," Notary Public a,w _ 13 I— My County of Residence: '4?'• iSdN -` David C. Thomas .;'^`•rAmEf] (Printed Name of Notary Public) Allen Prescribed by Stale Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form NO.201(Rev.1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. / /Payee t 4 vr�r,ry„ CofriA'ocAbr C'or/argA'c.r Purchase Order No. /°4 6a,' /0690 Terms Ao r-74 /« //4/85-3 Date Due Invoice Invoice Description Amount Date Number Numbber / (or note attached invoice(s) or bill(s))) 5/31//0 92e.5- �jJ / / /ci G / /7C Pi Prgp Cri/// 759:96 5/3/// 9806 f977/invf / 9o<, f'7C ,oijPrt% c -/(o/y1'2, 8, S /Y :rr ' r • Y , ``:) Total Y#3 9.40 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5-11-10-1.6. 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. J� L �- ALLOWED 20 /lCi•�rv'!�1`i•� 66 v51ro,1/i Gy CGr//rrtroz, IN SUM OF $ Pc) /0690 ON ACCOUNT OF APPROPRIATION FOR goz7y4/ oc?a7 Board Members Po»ca INVOICE NO. ACCT#/TITLE AMOUNT hereby certify invoice(s),Dear.a I hereb certi that the attached invoices , or got 96o C '/'/ooj'67 769.96 bill(s) is (are) true and correct and that the 502 9 • 6 yyA2s'ay 8,55-57Y materials or services itemized thereon for which charge is made were ordered and received except 6- 720 /0 Diret Signature o Operations Cost distribution ledger classification if Title claim paid motor vehicle highway fund