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Home My WebLink AboutHAGERMAN CONSTRUCTION CORPORATION - 1008 - 47,302.45 - 8/2/2010 tO AIA Document G702/CMa" - 1992 , 7-- Application and Certificate for Payment Construction Manager-Adviser Edition 2y TO OWNER: PROJECT:Parcel /A, Regime]. performing Arts APPLICATION NO: 25 Distribution to: Carmel Redevelopment Commission Center City of Carmel HCC Job #2613 PERIODTO:OS/31/10 OWNER El Carmel, IN 46032 Invoice #9791 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Hagerman Construction Corporation Shiel Sexton PROJECT NOS: 2695 / / CONTRACTOR ❑ P.O. Box 10690 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 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 G703,is below. iii Contract Documents,that all amounts have been paid by the Contractor for Work fur which previous Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 5,588,0 .00 payment shown herein is now due. - 2. Net change by Change Orders S 343,671.00 CONTRACT.:Hagerman C. struc ion Corporation !i. 3.CONTRACT SUM TO DATE(Line 1 t 2) $ 5,931,671.W By: _ _ _ PV::,s .Ma 20, 2010„ow 995.50 Slate of: O -is - ,� on— O er Q •• y 7yj ' • a. CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00025 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 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS IOIAL BALANCE, RETAINAGE ITESt DESCRIPTION OP WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO "IF vARJAHLE) NO. VALUE STORED AND STORED FINTSH APPLICATION THIS PERIOD (NOT M TO DATE (GEC) RATE (C-C) (D-E.) DORE) (D+ET-F) 0000010 GENERAL CONDITIONS 0000020 Bond 541,375.00 541,375.00 $0.00 $0.00 $41,375.00 100.000 $0.00 $0.00 0000030 General Conditions $169,586.00 $167,890.14 $0.00 $0.00 $167,890.14 99.000 51,695.86 $0.00 0000040 Supervision/Engineering $320,164.00 $316,962.36 $0.00 $0.00 $316,962.36 99.000 53,201.64 $0.00 0000045 Equipment/Operators $383,328.00 $383,328.00 $0.00 $0.00 5383,328.00 100.000 $0.00 $0.00 0000050 Owner Allowance $55,000.00 $42,222.00 $0.00 $0.00 $42,222.00 76.767 S12,778.00 $0.00 0000055 Subtotal General Conditions $969,453.00 $951,777.50 $0.00 $0.00 $951,777.50 98.177 $17,675.50 50.00 0000060 EARTHWORK 0000070 Excavation/Backfill $795,000.00 5771,150.00 $23,850.00 $0.00 5795.000.00 100.000 50.00 $0.00 0000080 Site Utilities $200,000.00 $160,000.00 $16,000.00 $0.00 $176,000.00 88.000 $24,000.00 50.00 0000090 Soil Treatment(Termiticide) $6,448.00 $6,448.00 $0.00 $0.00 $6,448.00 100.000 $0.00 50.00 0000095 Subtotal Earthwork $1,001,448.00 $937,598.00 $39,850.00 $0.00 $977,448.00 97.603 $24,000.00 $0.00 0000110 CONCRETE 0000120 Footings Labor $206,046.00 $206,046.00 $0.00 $0.00 $206,046.00 100.000 $0.00 $0.00 0000130 Footings Material $202,588.00 $202,588.00 $0.00 $0.00 $202,588.00 100.000 $0.00 $0.00 0000140 Foundation Walls/Piers Labor $603,561.00 5603.561.00 $0.00 $0.00 $603,561.00 100.000 50.00 50.00 0000150 Foundation Walls/Piers Material $414,224.00 5414,224.00 $0.00 $0.00 $414,224.00 100.000 50.00 $0.00 0000160 Slabs on Grade Labor 547,650.00 547,650.00 S0.00 $0.00 $47,650.00 100.000 $0.00 $0.00 0000170 Slabs on Grade Material $91,157.00 $91,157.00 $0.00 $0.00 $91,157.00 100.000 50.00 $0.00 0000180 Elevated Slabs Labor $29,485.00 $29,485.00 $0.00 $0.00 $29,485.00 100.000 $0.00 $0.00 0000190 Elevated Slabs Material $24,740.00 $24,740.00 $0.00 $0.00 $24,740.00 100.000 $0.00 5000 0000200 Elevator Shafts Labor $167,945.00 $167,945.00 $0.00 $0.00 $167,945.00 100.000 50.00 $0.00 0000210 Elevator Shafts Material $61,125.00 561.125.00 $0.00 $0.00 $61,125.00 100.000 $0.00 $0.00 0000220 Columns Labor $134,436.00 $134,436.00 $0.00 $0.00 $134,436.00 100.000 $0.00 $0.00 0000230 Columns Material $51,221.00 $51,221.00 50.00 50.00 $51,221.00 100.000 $0.00 $0.00 0000240 Slabs on Metal Deck Labor $116,191.00 $116,191.00 50.00 50.00 $116,191.00 100.000 $0.00 $0.00 0000250 Slabs on Metal Deck Material $245,878.00 $245,878.00 $0.00 $0.00 $245,878.00 100.000 $0.00 50.00 0000260 Topping Slab/Stair/Curb Labor $88,023.00 583,621.85 54,401.15 $0.00 $88,023.00 100.000 $0.00 $0.00 0000270 Topping Slab/Stair/Curb Material $61,026.00 $57,974.70 53,051.30 $0.00 $61,026.00 100.000 $0.00 $0.00 0000280 Rebar Labor 5239,605.00 $239,605.00 $0.00 $0.00 5239,605.00 100.000 $0.00 $0.00 0000290 Rebar Material 5406,775.00 $406,775.00 $0.00 $0.00 $406,775.00 100.000 $0.00 $0.00 0000300 Misc.Metals Labor 527,015.00 $27,015.00 $0.00 $0.00 527,015.00 100.000 50.00 50.00 AIA DOCUMENT G703•APPLICATION AND CER'r IPICATE FOR PAYMENT • 1992 EDITION • AIA71• C1992 • TIIE AMERICAN INS 11U'I'E CIFARClituCTS.1735 NEW YORK G703-1992 AVENUE.NW.,WASHINGTON.D.C. 200065292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'TN,OWnn'ray been rer.,sl,rua nbeorcat veto Pp pmnneln ct The MMCe Instants of A2,Lt tstee,!Gene 91003 to Pere/Ora Sntems,Inc.Neva:apron rr the occurrent xanrt pnlecrspmtc rnte,aLOnrs mt.perrLlned.COntaa MO Nnenry,tnyiEXe c1 A,:Aaec, to YCrIN tie nnee neryM C1 this M+mml and l atse status' • ' CONTINUATION SHEET AIA DOCUMENT G703 PAG132 OF PAGES ALA Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00025 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. ARCHITECT'S PROJECT NO.: 082613A A 13 C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE FFE61 DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RE;AINAGE IF NO. VALUE STORED AND STORED FPJISII VARIABLE) APPLICATION TIIIS PERIOD (NOT IN TO DATE (G+C) RAT E (C-Gl (D+E) D OR El (D+E+F) 0000310 Misc.Metals Material $38,003.00 $38,003.00 $0.00 $0.00 $38,003.00 100.000 $0.00 $0.00 0000315 Subtotal Concrete $3,256,694.00 $3,249,241.55 $7,452.45 $0.00 $3,256694.00 100.000 $0.00 $0.00 0000330 THERMAL AND MOISTURE PROTECTION 0000340 Insulation Labor $3,877.00 $3,877.00 $0.00 $0.00 $3,877.00 100.000 $0.00 $0.00 0000350 Insulation Material $15,268.00 $15,268.00 $0.00 $0.00 $15,268.00 100.000 $0.00 $0.00 0000360 Waterproofing Labor . $90,000.00 $90,000.00 $0.00 $0.00 $90,000.00 100.000 $0.00 $0.00 0000370 Waterproofing Material $122,960.00 $122,960.00 $0.00 $0.00 $122,960.00 100.000 $0.00 $0.00 0000380 Caulking Labor 513,300.00 513,300.00 $0.00 $0.00 $13,300.00 100.000 50.00 $0.00 0000390 Caulking Material 516,600.00 516,600.00 $0.00 $0.00 $16,600.00 100.000 $0.00 $0.00 0000400 Subtotal Thermal 8 Moisture Protection $262,005.00 5262,005.00 $0.00 $0.00 $262,005.00 100.000 $0.00 $0.00 0000420 SPECIAL CONSTRUCTION 0000430 Vibration Sound Control-Jack Up Floor Syste $98,400.00 $98,400.00 $0.00 $0.00 $98,400.00 100.000 $0.00 $0.00 0000450 CHANGE ORDER#01 0000460 Alternate Parking (520,000.00) ($20,000.00) $0.00 $0.00 (520,000.00) 100.000 $0.00 $0.00 0000480 CHANGE ORDER#02 0000490 Oculus Alternate 510,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000510 CHANGE ORDER#03 0000520 PC 1082-Elevator Changes $27,828.00 $27,828.00 $0.00 $0.00 $27,828.00 100.000 $0.00 $0.00 0000540 CHANGE ORDER#04 0000550 PC 10R2-Elevator Changes 511,926.00 $11,926.00 $0.00 $0.00 $11,926.00 100.000 $0.00 50.00 0000570 CHANGE ORDER#05 0000580 PC 18-Sanitary Sewer Force Main Piping 59,707.00 59,707.00 $0.00 $0.00 59,707.00 100.000 $0.00 $0.00 0000600 CHANGE ORDER#06 0000610 PC 05R1 -ASI#2 Speaker Boxes $26,221.00 $26,221.00 $0.00 $0.00 $26,221.00 100.000 50.00 $0.00 0000630 CHANGE ORDER#07 AIA DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • A1A99• CI992 • TIlE AMERICAN INSTITIfI'EOIt ARCHITECTS,1735 NEW YORK G703-1992 AVENUE.NW wASHING'FON.D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'TLrs6%ume,t nes beenrdcmOceC Bacort+ly with to permission d ire Ame,ran Institute CI MCnilects under Lceree 97003 to Pmpv era SyoMen,Inc RBPwucrien of this&JapriM'MMP'%en,ceo'c aromarion is not permitted.Comet The&narks Irntsts or Ait:iMs to vertu the CUr J■snien of at document and license status' • ' CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00025 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 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.: 082613A A B C D E F G H f WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OP WORK SCHEDULED FROM PREVIOUS % TO TF VARIABLE) NO. VALUE APPLICATION THIS PERIOD SPORED AND STORED FINISH RATE (NOT IN TO DATE (G4C) (C-G) (D+E) D OR E) (D+E+F) 0000640 PC 12R1 -Foundation Changes $5,744.00 $5,744.00 $0.00 $0.00 55,744.00 100.000 $0.00 $0.00 0000660 CHANGE ORDER#08 0000670 PC#15R1 -Reduce Size of HDPE Pipe ($1,175.00) ($1,175.00) $000 $0.00 (51,175.00) 100.000 50.00 50.00 0000690 CHANGE ORDER#09 0000700 PC 22-HDPE Single Wall Pipe $554.00 $554.00 50.00 $0.00 $554.00 100.000 50.00 $0.00 0000720 CHANGE ORDER#10 0000730 PC 23-Change Drainage Layer Stone 514,139.00 $14,139.00 $0.00 $0.00 $14,139.00 100.000 50.00 $0.00 0000750 CHANGE ORDER#11 0000760 PC 04R2-ASI#1 Modification to Utility Tunne $1,757.00 51,757.00 SO 00 $0.00 $1,757.00 100.000 $0.00 50.00 0000780 CHANGE ORDER#12 0000790 PC 06R2-ASI#3 Added Columns $12,142.00 $12,142.00 $0.00 $0.00 $12,142.00 100.000 50.00 $0.00 0000810 CHANGE ORDER#13 0000820 PC 09R2-ASI#6 Various Changes $22,449 00 $22,449.00 50.00 50.00 922,449.00 100.000 $0.00 $0.00 0000840 CHANGE ORDER#14 0000850 PC 09R2-ASI#6 Various Changes $32,257.00 $32,257.00 $0.00 $0.00 $32,257.00 100.000 $0.00 $0.00 0000870 CHANGE ORDER#15 0000880 PC 02R1 -Added 8 Extended Piers $6,578.00 $6,578.00 $0.00 $0.00 56,578.00 100.000 $0.00 $0.00 0000900 CHANGE ORDER#16 0000910 PC 35-Water Main Sleeve 51,757.00 51,757.00 50.00 $0.00 $1,757.00 100.000 $0.00 $0.00 0000930 CHANGE ORDER#17 0000940 PC 05R1 -Speaker Boxes-West $29,820.00 $29,820.00 $0.00 $0.00 $29,820.00 100.000 $0.00 $0.00 0000960 CHANGE ORDER#18 0000970 PC 34R2-ASI#40 Sanitary Force Main $18,987.00 $18,987.00 $0.00 $0.00 $18,937.00 100.000 $0.00 $0.00 AIA DOCUMENT G703•API'LICAI'ION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AINr• 91992 • THE AMERICAN INS!'ITU'I'F OF ARCHITECTS,1735 NEW YORK G703-1992 AVENUE,N.W..WASIIINGTON.D.C. 210/6-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'RNs dovrrtim has Wen repTduml elcmcallyw'en nepnmasa,at The Amer pn Institute ofapalocts urg e,loons@ 9700310 Prnur+ra Syslnna,!IC. RepMUPM of so do-re It wttCW •ONRagotc inlo,te ta.,s IXII pnmLted.CCn1'a0 tie MinOncan Institute of nrt,MS to catty the areni version of nia eccumenl and license stanza.' CONTINUATION SHEET AIA DOCUMENT G703 PAGE 4 OF 5 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT. APPLICATION NO.: 00025 containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts arc stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D li F G H I - WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED ° TO F VARI AGE DESCRIPTION OF WORK FROM PREVIOUS °' 1F VARIABLE) NO. VALUE APPLICATION THIS PERIOD NORT:D AND STORED FINISH RATE ( (NOT IN TO DATE (G+C) (C-G) (D-E) 0 OR E) (D+E+F) 0000990 . CHANGE ORDER#19 0001000 Credit for Commercial Stone in lieu of INDOT ($6,800.00) ($6,800.00) $0.00 $0.00 (56.800.00) 100.000 $0.00 $0.00 0001020 CHANGE ORDER#20 0001030 PC 26-ASI#11 Added Curbs $5,428.00 $5,428.00 50.00 $0.00 $5,428.00 100.000 $0.00 $0.00 0001050 CHANGE ORDER#21 0001060 PC 27R2-ASI 17 Utilitly Vault Modifications $8,505.00 $8,505.00 $0.00 50.00 $850500 100.000 50.00 $0.00 0001080 CHANGE ORDER#22 0001090 PC 07-Unsuitable Soils at Tunnel $22,060.00 $22,060.00 $0.00 $0.00 $22,060.00 100.000 $0.00 $0.00 0001110 CHANGE ORDER#23 0001120 PC 03-Unsuitable Soils $9,520.00 $9,520.00 $0.00 $0.00 59,520.00 100.000 $0.00 $0.00 0001140 CHANGE ORDER#24 0001150 PC 33-Unsuitable Soils $3,678.00 $3,678.00 $0.00 $0.00 $3,678.00 100.000 50.00 $0.00 0001170 CHANGE ORDER#25 0001180 PC 37-Generator Slab 52,132.00 $2,132.00 $0.00 $0.00 $2,132.00 100.000 $0.00 $0.00 0001200 CHANGE ORDER#27 0001210 PC 31 Added Masonry Footing $3,751.00 $3,751.00 $0.00 $0.00 $3,751.00 100.000 $0.00 $0.00 0001230 CHANGE ORDER#28 0001240 PC 41R1 ASI#27 SOG Modifications $4,293.00 $4,293.00 $0.00 $0.00 $4,293.00 100.000 50.00 $0.00 0001260 CHANGE ORDER#29 0001270 PC 28R1 ASI#18 Garbage Vacuum Pit $3,181.00 $3,181.00 $0.00 $0.00 $3,181.00 100.000 $0.00 $0.00 0001290 CHANGE ORDER#30 0001300 PC 29 ASI#21 South Entrance Stairs $7,870.00 $7,870.00 $0.00 $0.00 $7,870.00 100.000 $0.00 $0.00 AIA DOCUMENT G703-APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA9• C1992 • THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK G703-1992 AVENUE.N.w.,WASHINGTON,D.C. 20106-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'Trw'isomers has been repeodw°eVestionicaln Cl with ms pe nano el ltd Amwtan Instils%of Aet,l is undo.Llama 97003 to fwna,,e,a Systems.Inc.Fepeawbn m On a°anvxv want pgecvspootc,nMnetan Is tel w,mttua.Conlaa The A.m:ran Insrw:e n Arcnn°as to cents Me a.,eet.assn el eln=sunsets and pane vans • • . CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00025 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts arc stated to the nearest dollar. PERIOD TO: 5/31/2010 Use Column Ion Contracts where variable retainaee for lint items may apply. ARCHITECTS PROJECT NO.: 082613A A R C D Ii F G II I WORK COMIPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED TO FVARI AGE DESCRIPTION OF WORK FROM PREVIOUS IF VARIABLE) NO. VALUE STORED AND STORED FINISH APPLICATION THIS PERIOD NOT IN TO DATE (Gi-C) RATE (C-G) (D+E) I)OR E) (D+E+F) 0001320 CHANGE ORDER#31 0001330 PC 30R1 ASI#22 Platform Lift Plt $5,106.00 $5,106.00 50.00 $0.00 $5,106.00 100.000 $0.00 $0.00 0001350 CHANGE ORDER#32 0001360 PC 36R4 Column Encasement East $27,521.00 $27,521.00 $0.00 $0.00 $27,521.00 100.000 $0.00 $0.00 0001380 CHANGE ORDER#33 0001390 PC 36R4 Column Encasement West $28,000.00 $28,000.00 $0.00 $0.00 528,000.00 100.000 $0.00 $0.00 0001410 CHANGE ORDER#34 0001420 PC 43R1 Slab Openinos $1,414.00 51414.00 $0.00 $0.00 51,414.00 100.000 $0.00 50.00 0001440 CHANGE ORDER#35 0001450 PC 45R1 Saw Cutting of Foundation Wall 51,419.00 $1,419.00 50.00 $0.00 $1,419.00 100.000 $0.00 $0.00 0001470 CHANGE ORDER#37 0001480 PC 42R1 -ASI 468 Columns Modifications $2,671.00 52,671.00 $0.00 50.00 $2,671.00 100.000 $0.00 $0 00 0001500 CHANGE ORDER#38 0001510 PC 51 Chipping Gutter Wall to 4' $1,784.00 $1,784.00 $0.00 $0.00 $1,784.00 100.000 S0.00 $0.00 0001530 CHANGE ORDER#39 0001540 PC 49 Locate Water Main Valve $1,447.00 51,447.00 $0.00 $0.00 $1,447.00 100.000 $0.00 $0.00 $5,931,671.00 $5,842,693.05 $47,302.45 50.00 $5,889,995.50 99.30% $41,675.50 $0.00 AIA DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT • 199'_EDITION • AIAin• ©1992 • THE AMERICAN INSTITIJ1EDF ARCHITECTS.1735 NEW'CORK G703-1992 AVENUE.KW..WASHINGTON,U.C. 20006.5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'ids aoomsem has been neproassche eseecradentsy Ash lM perrmNP a The Arne an Insulate of Mooed,under tcen.e S7 2 la PnI.era Systems.Inc RLOMUdlon el des ancorent anl1WI p,oIRspedic mb•mauon is not G¢otrv:IO.Comma PC Amencan u111-Se 0 n l0atecb In venn me current sermon of Mrs oKVnenl and Kara.sedan" WAIVER OF LIEN The undersigned is the duly authorized office rof Hagerman rnnal-rnrt-ion rnrporation ,the general contractor, (Name of Company) subcontractor,'materialman or other person furnishing the services, labor, material or•equipment indicated below in.the construction of improvements upon real estate located in Ham;1 ton County, State of Indiana , commonly known as Cannel Performing Arts which real estate Is owned.byrarmei Rarlevinpment ("Owner"). Center Commission INCONSIDERATIONofthesumof Five millicn five hurrired ninety three rthasard far hundraf eleven and 95/100 DOLLARS($ 5,593,411.95 ),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 herebywaive,•reiease 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 Yens upon the land or improvements above described which the Company may now have forservices,labor,material or equipmentfumished in respect of such land orimprovernents to and including the date hereof. The u ndersignedwarrants that the Company has not and will not assign any claim for payment 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 states that the Consideration received hereunder Is the soleconsideration 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'tithe affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has complied with all prevailing wage requirements under applicable law or as may be set forth in the contract documents. . WITNESS the execution hereof this 20th day of May 2010 • .� s ( a andd TtII 1 Troy Heisler, controlRler - Hagerman rnnstnirtinn rnrrnrni-nn • (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 Hei sler the controller , of _ .- . , 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 20th da of May • 2010 PPPP vokargi,t,e4, Oaa-- . My Commission Expires: �fiberl� •;• *. o oft'Ir`� , Notary Public Noraf♦ys My County of Residence: 913,4••tE • tv..%•; David C. Thomas °!n'• ... arnTFo`. (Printed Name of Notary Public) .V� Allen • Prescribed by State Board at Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER 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 (70,754-0e(uy54-0e o'7 Ccr 79 sivA o37 Purchase Order No. _ /'Ogo,r /&o5'0 Terms ,1- // 4165 5 3 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 513///0 2 ' 4„04974.-0P7 ZS /° 7 y1 3 a2.5s T 3 4 Total �3o2.vS 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. � ALLOWED 20. // y✓r 4 Coe sfr4,e- 'orro.ry .00 IN SUM OF $ • AU o,r /069c' 53 $ y7305,' . �s ON ACCOUNT OF APPROPRIATION FOR Board Members POI;or INVOICE NO. ACCT#ITITLE AMOUNT hereby certify invoice(s),DEPT.a I hereb certi that the attached invoices , or 9o2 2.S yU6O F-c 7 4,7 302.Y5" bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 6 -V 20 /0 Signature Dfreetereffkftclopment Cost distribution ledger classification if PAID AUG - 4 2010 claim paid motor vehicle highway fund P A /�