GEIGER & PETERS, INC. - 1209 - 23,899.50 - 9/16/2010 APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION PAGE ONE OF FIVE PAGES
AIA DOCUMENT G7021CMa (Instructions an reverse side)
•
TO(OWNER): City of Cannel Community Develop.Corp. PROJECT:Village on the Green APPLICATION NO.:04-09119 Distribution to:
30W Main St Suite220 City Center Dr 63rd Ave SW PERIOD TO: 7/31/10 OWNER '
Carmel..IN 46032 Carmel IN 46032 PROJECT NOS: CONSTRUCTION MANAGE!
VIA(CONSTRUCTION MANAGER): REI Construction ARCHITP.CI4T
FROM(CONTRACTOR): Ceiger di Peters,Inc. 11711N Pennsylvania St Suite 200 CONTRACT DATE: CONTRACTOR
P 0 Out 33807 Cannel,IN 46832
Indianapolis,Indiana 46203
317_359.9521
CONTRACT FOR Structural Steel "
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned ContractorcertifiiesthattothebestoftheContractor'sknowledge,Infor-
Application Ia made for Payment,as shown below,in connection with the Contract. mason and belief the Work covered by this Application for Payment has been completed
Continuation Sheet,AIA Document 0703,is attached. in accordance with the Contract Documents,that all amounts have been paid by the
Contractor for Work for which previous Certificates for Payment were issued and pay-
1.ORIGINAL CONTRACT SUM.......... .................._............,. $ 800,93000 merits received from the Owner,and that current payment shown herein is now due.
2.Net change by Change Orders 5 54,130.00 CWPJYRACTDR1: 1� It
3.CONTRACT SUM TO DATE(Lee 1+2) . 5 855.060.00 BR�K.jl A._kt.�`_1ry)-LGCtr-rm Date' 7119130
4_TOTAL COMPLETED&STORED TO DATE $ 804,735_00
(Column G on G703) Stated: Were
County at Mann
5 RETAINAGE: Stlbseinidandiwprniobnore
a. 10 %of Completed Work meth's 19th deyd July,2010
(Column D+E on 0703) $ 00.473.50_
b t0 %of Stored Malarial /
(Column F on G703) $ _ /( „�7 Ana,-. rRISTINF NI. r3RACE
Total Reairtage(Line 5a+56 or /,�-C-! /, r??X--J'-`"✓"-�- /" r°'N %nor pithL hate oflnCiala
Total in Cohan I of G703 f^e_
) $ 80<73,50 Notary Public Kristine M Grace I} 4 "ABfrOG County
my Commission expires: 6/612013 `` �'.�. My Oorpjnrssion Expire `
6.TOTAL EARNED LESS RETAINAGE - -- $ 724261.50 J �Pp • tune 06,2013 t)L
(Line 4 less Lim 5 Total)
ARCHITECT'S CERTIFICATE FOR PAYMENT
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In accordance with the Contract Documents,based on on-site observations and the data
(Line 6 from prior Cettihcate) $ 700,3a2,00 comprising this application,the Architect certifies to the Owner that to the best of the
Owner's knowledge,information and belief the Work has progressed as indicated,the
quality of the Work is in accordance with the Contract Documents,and the Contractor
8.CURRENT PAYMENT DUE Fs 23,899.50 1 is entitled to payment of the AMOUNT CERTIFIED.
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED. s 7'R 87 -I a So
(Line 3 less Line 6) $ 130,798.50 (Attach explanation tfamnanl certified differ;from the amount app liedfrm. Initial
all figure,on fits Application and on the('onrimtafan Sheer IAN ore changed to
confemt to the amount rerr fled)
CONSTRUCTION MANAGER:
ToAlthangtappMMedV hnbmoNS. nE000riarl9 / - : /����
Total rtivlga approved in By. .,.....2°-4e...°:/[.4.
/c/' -4e 'S Data / /
reviou5 months by Owner 5
-
TotalapprovedOdsmonOt s 14.13000 ARCHITECT:
ffi, TOTA15 s 54,100.00
— B: -
Date
.2c crduvESa[rwtadm „,s
£5453000 Is efts kale Is not negotia•e - A•e 1 C '- 'I D Is payable only to the Con-
tractor named herein. Issuance,payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA note MENT C?ONCMa'APPLICATION AND CERTIFICATE FOR PAYMENT'CONSTRUCTION M NACER-ADVISER EDR1ON D SEA 1 7 ?(lip
1991 ED`ION'1992•AtA 1992 THE AMERICAN INSTITIrt£OF ARCHITECTS,3 T3 NEW YORK AVENUE.N.W.,WAS BI NOION, GTO].l Cma-1992 I
D.C.b1055292 ./j. ti
.. CONTINUATION SHEET ALA DOCUMENT 6703 (Instructions on reverse side) PAGE TWO OF FIVE PAGES . -
AIA Document G702.APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NO.: 08-09119
Contractors signed Certification is attached. Geiger& Peters APPLICATION DATE: 7/19/10
in tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 7/31/10 -
Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO:
A 13 C 0 I E F G H I
SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE
VALUE FROM PREY€OUS THIS PERIOD PRESENTLY COMPLETED (G:C) TO FINISH
ITEM DESCRIPTION OF APPLICATION STORED AND STORED (C-G)
NO. WORK ESTIMATED {DfE) (NOT IN TO DATE
COST D OR E) (Di-E+F)
3 rxwionae Shop Drawing's 5 38,700.00 $ 38,700.00 $ - $ 3R700.00 100% $ - $ 3,870.00
2 Anchecaoas/Embeds $ 5,800.00 5 6,500.00 $ - $ 6,800.00 100% $ - $ 680.00
3 Papr:mt k Performance Bond $ 4,000.00 5 4,000.00 $ - $ 4,000.00 100% $ - S 400,00
4 NOSl20 Structural Steel 5 -
5 rebai ati ou&Meicdn! 5 432,670.00 $ 432,670.00 $ - $ 432,670.00 100% $ - $ 41267.00
6 Erecaon $ 94,620.00 $ 94,620.00 $ - $ 94,620.00 100% 5 - $ 9,462.00
7 NO52100 Steel Joist $ -
8 Mai vlal S 26,50000 $ 26,500.00 $ - $ 26,500,00 100% $ - $ 2,650,00
9 eranon $ 14,600.00 $ 14,600_00 $ - $ 14,600.00 100% $ - S 1,460.00
10 N053lDAoorDeek $ -
I I Material $ 10,360.00 $ 10,360.00 5 - S 10,360.00 100% S - $ 1.036.00
12 Erection 5 5,1 80.00 5 5,180.00 $ - 5 5,180.00 100% 5 - $ 518.00
13 ro536o Hoar Deer $ -
14 Materiel 5 31,200.00 5 31,200.00 $ - $ 31,200.00 100% S $ 3.120.00
I5 Erection S 15,600.00 $ 15,600.00 $ - $ 15,600.00 100% S - $ 1,560.00
16 005500 Metal Fabrication
17 Material $ 5,600.00 $ 3,640.00 $ 1,960.00 5 5,600.00 100% $ - $ 560.00
18 trecton $ 1,500.00 S 525.00 $ - $ 525.00 35% $ 975.00 $ 52.50
19 X05510 Metal Stain
20 Material $ 44,300.00 $ 28,795.00 $ 15,505.00 5 44,300.00 100% 5 $ 4.43000
21 Erenioa $ 18,100.00 $ 10,860.00 $. 7,240.00 S 18,100.00 100% $ - $ 1,810.00
22 X055213 Tube FesitinR
23 Material $ 7,400.00 $ 1,85000 $ 1,850.00 25% $ 5.550.00 $ 185.00
24 erMdon $ 4,200.00 5 - 0% $ 4,200.00 $
25
5 761,330.00 $ 724,050.00 $ 26,555.00 $ - $ 750,605.00 99% $ 10,725.00 $ 75,060.50
ALA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK
AVENUE,N.W.,WASHINGTON,D.C. 20006-5292
6703-1992
CONTINUATION SHEET ALA DOCUMENT G703 (Instructions on reverse side) PAGE THREE OF FIVE PAGES
AIA Document G702.APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NO.: 08-09119
Contractors signed Certification is attached. APPLICATION DATE: 7/19/10
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO 7/31/10 . -
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
A B C D F F G H I
SCHEDULED WORK COMPLETED MATERIALS TO'I'AI. %a BALANCE RETAINAGE
VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (GC) TO FINISH
ITEM DESCRIPTION OF APPLICATION STORED AND STORED (C-G)
NO. WORK ESTIMATED (D+E) (NOT IN TO DATE
COST D OR E) (D+E+F)
26 RR57300 Ueroe.ti.M Metal Railing.
27 Malaria $ 26,800.00 5 - 0% 5 26.800.00 $
28 Erection $ 12,800,00 5 - 0% $ 12,800.00 $
29
30 c/o 54,130.00 $ 54,130.00 $ - 5 54.130.00 100% $ - 5 5,413.00
31 'C/On RSA ICO
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
$ 855,060.00 5 778,180.00 S 26,555.00 $ - $ 804,735.00 94% 5 50,325.00 $ 80,473.50
AIA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION MA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE,N.W., WASHINGTON, D.C. 20006-5292
6703-1992
•
WAIVER OF LIEN TO DATE •
STATE OF Indiana J
COUNTY OF Marron J SS
TO WHOM IT MAY CONCERN:
WHEREAS the undersigned has been employed by REI Construction
to furnish Structural Steel
for the premises knows as Village on the Green
of which City of Carmel Community Develop. Corp. is the owner.
THE undersigned,for and in consideration of Twenty Three Thousand Eight Hundred Ninety Nine and 50/100
(S 23,899.50 ) Dollars,and other good and valuable considerations,the receipt whereof is hereby acknowledged,do(es)hereby
waive and release any and all lien or claim of,or right to,lien,under the statutes of the State of Indiana,relating to mechanics'liens,with respect to
above-described premises,and the improvements thereon,and on the material,fixtures, apparatus or machinery furnished,and on the moneys,
funds or other considerations due or to become due from the owner, on account of all labor,services,material,fixtures, apparatus or machinery,
furnished to this date by the undersigned,for the above described premises,including extras..
DATE 7/19!2010 COMPANY NAME Geiger&Peters Inc.
ADDRESS P O Box 33807 Indianapolis,IN 46203
�� QQ
SIGNATURE AND TITLE / Lt 5 Y�{.�1r.M.l.l.x — Controller
*EXTRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE ORDERS,BOTH ORAL ANT)WRITTEN,TO THE CONTRACT,
CONTRACTOR'S AFFIDAVIT
STATE OF Indiana J
COUNTY OF Marion ) SS
TO WHOM IT MAY CONCERN:
THE UNDERSIGNED, Debra Burton BEING DULY SWORN,DEPOSES
AND SAYS THAT HE OR SHE IS Controller OF
Geier&Peters Inc. WHO IS THE
CONTRACTOR FURNISHING Structural Steel WORK ON THE BUILDING
LOCATED AT City Center Dr&3rd Ave SW Cannel IN 46032
OWNED BY City of Cannel Community Develop.Corp.
That the total amount of the contract including extras.is S 855,060.00 on which he or she has received payment of
$ 700,362.00 prior to this payment. That all waivers are true,correct and genuine and delivered unconditionally
and that there is no claim either legal or equitable to defeat the validity of said waivers. That the following are the names and addresses of all
parties who have furnished material or labor,or both,for said work and all parties having contracts or sub contracts for specific portions of said
work or for material entering into the construction thereof and the amount due or to become due to each,and that the items mentioned include all
labor and material required to complete said work according to plans and specifications:
NAMES AND ADDRESSES WHAT FOR cnNrRACTVaICe AMOUNT THIS BALANCE DUE
inCLwlaa ExiRAS• PAID PAYMENT
Geiger&Peters Inc. Structural Steel 855,060.00 700,362.00 23,899.50 130,798.50
TOTAL LABOR AND MATERIAL INCLUDING EXTRAS TO COMPLETE 855,060.00 700,362.00 23,899.50 130,798.50
That there are no other contracts for said work outstanding,and that there is nothing due or to become due to any person for material,labor or
other work of any kind done or to be done upon or in connection with said work other than above stated.
DATE 7/19/2010 SIGNATURE: raia_V itfa &u`SUBSCRIBED AND SWORN TO BEFORE ME THIS 19th DAY OF July 2010
a g,� -+�i n A-rt i2
Kristine M Grace Resident of on County My Commission expires 6/6/2013
°EXTRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE ORDERS.BOLL ORAL AND WRITTEN,TO THE CONTRACT.
CTIZZ;• i91S7INFr N•CHACE
{((,;i) maty lotIndian?-
vo Corrr,,ission Expire:
• :11 wub,2013