VERKLER CONSTRUCTION- 180- 3/1/2011 •
Verkler Construction Check: 180
7240 Georgetown Road Date: 3/1/2011
Indianapolis, IN 46268 Vendor: VERKLER1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
4 60,861.15 60,861.15 0.00 0.00 60,861.15
App 4 on Black Box Theater fin
60,861.15 60,861.15 0.00 0.00 60,861.15
180
3/1/2011 ******`""60,861.15
THE SUM OF SIXTY THOUSAND EIGHT HUNDRED SIXTY ONE DOLLARS AND 15 CENTS t*****""
Verkler Construction
7240 Georgetown Road
Indianapolis, IN 46268
Verkler Construction Check: 180
7240 Georgetown Road Date: 3/1/2011
Indianapolis, IN 46268 Vendor: VERKLER1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt, Paid
4 60,861.15 60,861.15 0.00 0.00 60,861.15
App 4 on Black Box Theater fin
60,861.15 60,861.15 0.00 0.00 60,861.15
APrPCJCATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION
Abl DOCUMENT G702/GMa
PAGE ONE OF PAGES
TO: City of Carmel Community Development PROJECT: Village on the Circe]]Office Building Black Box
Corporation Theater-Bid Item#2, Finishes APPLICATION NO: 04 Distribution To:
803 3rd Avenue SW and Grrity:Cleiitef,l.7r�ive; �'I l j PERIOD TO: 12/31/2010 DOWNER
Carmel, EN 46032 EI) 1 ( 1� '�' 1-6 PROJECT NOS: 10-006 El CONSTRUCTION
`i ' DEC '; -91c'1 III `l I MANAGER
FROM: l crklL cncorpor_ ateli I'I�`` �J CONTRACT DATE: 8/30/2010 ❑ ARCHITECT
7240 Georgetown Road I ❑ CONTRACTOR
Indianapolis, IN 46268 VIA CONSTRUCTION MANAGER:REluG.onstruction, LLC.
CONTRACT FOR: Bid Item#2 C
VIA ARCHITECT: Pedcor Design Group LL
CONTRACTOR'S APPLICATION FOR PAYMENT The undersitmed Contractor certifies that to the best of the Contractors knowledge,Infor-
mation and belief the Work covered by this Application for Payment has been completed in
Application is made for payment, as shown below, in connection with the Contract. accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and payments
1. ORIGINAL CONTRACT SUM $ $192,385.00 received from the Owner, and that current payment shown herein is now due.
2. Net Change by Change Orders . $ $22,677.34
3. CONTRACT SUM TO DATE (Line 1 _2) . . . _ _ . . , . _ $ $215,062.34 CONT TOR:
4. TOTAL COMPLETED & STORED TO DATE. . . . . . . . . . $ $153,802.00 B 12.79p '219/6
(Column C on 0703)
y— Date.
RETAINAGE:
�' $ $15,380.20 State of: Indiana
a. 3000%of Completed Work County of. Marion
(Columns D+E on G703)
Subscribed and sworn to before
b. 10.00%of Stored Material me this 30th day of December.20]0
(Column F on(1703) S $0.00
Total Retainage(Line 5a+5b or
Total in Column I on G703) $ $15,330,20
6. TOTAL EARNED LESS RETAINAGE . $ $138,421.80 Notary Public: Janeane Arbuckle
(Line 4 less Line 5 'Total) My commission expires: March 20 2 3
LESS PREVIOUS CERTIFICATE FOR PAYMENT
$ $77,560.65 CERTIFICATE FOR. FiAYMENT
8. CURRENT PAYMENT DUE $ $60,861.15 In accordance with the Contract Documents, based on on-site observations and the data
9. BALANCE TO FINISH INCLUDING RETAINAGE comprising the application, the Construction Manager and Architect certifies to the Owner
that to the best of the their knowledge, information and belief the Work has progressed as
(Line 3 less Line 6) $76,640.54 indicated, the quality of the Work is in accordance with the Contract Documents, and the
Contractor is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED
CHANCE.ORDER SUMMARY $ ODE" I. IC
ADDITIONS _ DEDUCTIONS (Attach ecplafration if amount certified dyers from the amount applied for. Initial aN
Total changes approved in figures on this Application and on the Continuation Sheet that are changed to conform in
the amount certified)
previous months by Owner CONSTRUCTION MANAGE :
Total approved this Month $22,677.34 By: Date: /12 i rb t
TOTALS ARCHITECT:
522,677.34 _ $0.00 By: Date:
I NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Y g $22,677.34 Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AU DOCUMENT G702/CMa•APPLICATION AND CERTIFICATION FOR r•AYMENT•1992 EMIT:•&IA •01992-THE AMERICAN INSTITUTE 07.ViCHr'rEcrs,t 1S5 NEW YORK
A V ENHL,N,W,WASHINGTON,DC 20)06-5292•Users may obtain validation of this document by requesting a completed AIA Document 0601-Certification of Document's Authenticity from the Licensee.
c-ino]ras.,_t On,
CONTINUATION SHEET AM DOCUMENT G703 PAGE 1 OF 3 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 04
Contractor's signed Certification is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. TO:
Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 10-006
ARCHITECT'S PROJECT NO:
NET CHANGES by Change Order $22,677.34 1 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment arc without
prejudice to any rights of the Owner or Contractor under this Contract.
MA DOCUMENT G702•APPLICATION ANO CERTIFICATION FOR PAYMENT•]992 EDITION•AlA •01992.•THE AMERICAN INSTI TUTT OF APCHITECTS,ins NEW YORK
AVENUE.N.W.,WASHINGTON',DC 2000e-5292•Users may obtain validation ofthls document by requesting a completed MA Document 0401-Certification of Document's Authenticity from the Licensee.
. G702-1992
A B C D E F G H I
# Description of Scheduled Previous Work Work Presently Total % Balance to Total Retainage
Work Value Complete Completed from Stored Completed 8 Finish
_ This Period Stored to Date
General
Conditions _
0001 Supervision, $7,990.00 $5,193.50 $1,198.50 $0.00 $6,392.00 80.00% $1,598.00 $639.20
Clean up, Etc. _
General Subtotal: $7,990.00 $5,193.50 $1,198.50 $0.00 $6,392.00 80.00% $1,598.00 $639.20
Conditions
—
Bid Item#1
0002 Architectural $7,500.00 $3,750.00 $0.00 $0.00 $3,750.00 50.00% $3,750.00 $375.00
Woodwork -
Mat'I
0003 Architectural $2,600.00 $260.00 $0.00 $0.00 $260.00 10.00% $2,340.00 $26.00
Woodwork-
Labor -
0004 Flooring and $28,500.00 $7,125.00 $14,250.00 $0.00 $21,375.00 75.00% $7,125.00 $2,137.50
Base- Mafi
0004 Flooring and $7,000.00 $350.00 $0.00 $0.00 $350.00 5.00% $6,650.00 $35.00
Base-Labor
0006 Painting and $28,000.00 521,000.00 $7,000.00 $0.00 $28,000.00 100.00% $0.00 $2,800.00
Wall Covering-
Mat'I
0007 Painting and $15,000.00 $7,500 00 $6,000.00 $0.00 $13,500,00 90.00% $1,500 00 51,350.00
Wall Covering-
Labor
0008 Sound $22,000.00 $2,200.00 $8,800.00 $0.00 $11,000.00 50.00% $11,000.00 $1,100.00
Absorbing Well
Units- Mali
0009 Sound $8,000.00 $0.00 $0.00 $0.00 $0.00 0.00% $8,000.00 $0.00
Absorbing Wall
Units-Labor
0010 Stage Curtains $38,000.00 $19,000.00 $19,000.00 $0.00 $38,000.00 100.00% $0.00 $3,800 00
and Acoustical
Draperies - Mal'l
t4
CONTINUATION SHEET AlA DOCUMENT G703 PAGE 2 OF 3 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 04
Contractor's signed Certification is attached. APPLICATION DATE:
in tabulations below, amounts are stated to the nearest dollar. TO:
Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 10-006
ARCHITECT'S PROJECT NO:
0011 Stage Curtains ' $8,000.00 $6,000.00 $800.00 $0.00 S6,800.00 85.00% $1,200.00 $680.00
and Acoustical
Draperies-
Labor _
0012 Black Out $8,000.00 $800.00 $7,200.00 $0.00 $8,000.00 100.00°/ $0.00 $800.00
Blinds-Mat'l
0013 Black Out $2,295.00 $0.00 $0.00 $0.00 $0.00 0.00% $2,295.00 $0.00
Blinds- Labor _
0014 Joint Sealants, $2,500.00 $0.00 $1,875.00 $0.00 $1,875.00 75.00% $625.00 $187.50
Concrete Sealer
-Mat'l
0015 Joint Sealants, $2,000.00 $0.00 $1,500.00 $0.00 S1,500.00 7500% $500.00 $150.00
Concrete Sealer
- Labor
0016 Masonite Floor $1,500.00 $0.00 50 00 $0.00 $0.00 0.00% $1,500.00 $0.00
Protection-
Mat'l
0017 Masonite Floor $3,500.00 30.00 $000 $0.00 $0 00 0.00% $3,500.00 $0.00
Protection-
Labor
Bid Item#1 Subtotal: S184,395.00 $67,985.00 $66,425.00 $0.00 5134,410.00 72,89% $49,985.00 $13,441.00
CO#1 - Add for
PR#5
001 Add for PR#5 $22,677.34 $13,000.00 $0.00 $0.00 $13,000.00 57.32% $9,677.34 $1,300.00
CO#1 -Add for Subtotal: $22,677.34 $13,000.00 $000 $0.00 $13,000.00 57.33% $9,677.34 $1,300.00
PR#5
-
GRAND TOTAL $215,062.34 $86,178.50 $67,623.50 $0.00 $153,802.00 71.52% $61,260.34 $15,380.20