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222480 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 367177 Page 1 of 1 0 `F ONE CIVIC SQUARE LENEX STEEL COMPANY CARMEL, INDIANA 46032 250 E 96TH ST SUITE 150 CHECK AMOUNT: $11,435.00 INDIANAPOLIS IN 46240 CHECK NUMBER: 222480 CHECK DATE: 7/30/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 3 11, 435 . 00 PERFORMING ARTS CENTE O ai> At TM Document 070.2 ® 1 2 Application and Certificate for PayM.pnt TO OWNER: Carmel;,Redevelop:Commission PROJECT: Palladium Steel Retrofit APPLICATION NO_ 3 Distribution to: 30 W.Main'St.,Suite 220 PERIOD T0. OWNER ❑ Garmel'IN 46032 ' - Q(�// 3 5t1 U 3c 20� CONTRACT FOR: ctu aTSteel ARCHITECT ❑ FROM CONTRACTOR: .ARCHITECT: Lenex Steel Company CONTRACT DATE:.. CONTRACTOR X❑ 250 East 96th Street PROJECT NO.S: 561-13 1 1 FIELD ❑ Suite 150 Indianapolis IN 4624 0 OTHER ❑ CONTRACTOR'S APPLICATION FM PAYMENT The undersib ed Contractor certifies that to the best of the Contractor's knowledge 'information 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 AIA Document G703TM,Continuation Sheet,is attached. with the Contract Documents'.'that all amounts have been paid by the Contractor for Work for which previous Certificates forr Payment were issued and.payments received from the Owner, and 1.ORIGINAL CONTRACT SUM ..... ............ $ 82;000.00 that current payment shown he' rein now due... 2. NET CHANGE BY CHANGE ORDERS $ 0.00 CONTRACTOR: nex Stee/ MZ, CONTRACT SUM TO DATE(Line 1 t 2) ...... ........ ......... $ 82,000.00 By: Date: �/ t 4.TOTAL COMPLETED&STORED`TO DATE(Column G on G703) ...... $ 82,000.00 State of: Indiana 5.RETAINAGE: County ofHamilton a.5.00 %of Completed Work Subscribed and sworn to before (Columns D+Eon G703) $ 4,100.00 me this �`� day of b5.00 %of Stored Material 0.00 f i TAMMY L DE4 (Column F on G703) $ Notary Public: Mar , c u A—�Gt'J 1�P U a,... l - - — _ � Marion Cou '} My commission expires: �roTS r My o TSmicc , 4!,eG Total Retainage(Lines 5a+5b, or Total in Column 1 of.G703)...... $ 4,100.00 6.TOTAL EARNED LESS RETAINAGE ............................:........ $ 77,900.00 CERTIFICATE FOR PAYM (Line 4 minus Line S Total) In accordance with the Contract Documents,based on on,site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT .......... ........... $ 66,465.00 this application,the Architect certifies to the Owner that to the best of the'Architect's,knowledge, (Line 6 from prior Certificate) information and belief the Work.has progressed as indicated, the quality of the"Work is in accordance with the..Contract Documents,: and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE :... $ 11,435.00 AMOUNT CERTIFIED 9:BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED ✓6,✓ 7Np`� ��2 41 `fir ....... ..... $ (Line 3 minus Line.6 $ 4,100.00 (Attach explanation if amount cork red, if er. rpm the amount npplied.Initial all figures on this Application and on the enuation Sheet that are chanted to conform with.the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved iti previous months by Owner $ ' $ By: Date Total approved this month $ $ This Certificate is,not negotiable:The'AMOUNT CERTIFIED is payable only to the Contractor TOTAL. .b.00 $ nd"acceptance of payment.are without prejudice to any rights of - named herein Issuance,payment.a ET CHANGES by Chan e Order $ 0'.00 ` the Owner or Contractor tinder 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 G702TI—1992.Copyright @ 1953,1963,1965,1971;1978,1983 and 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 AWA Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum exte nt possible under the law.Purchasers are 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. , 01071 1AC044 .. TM ®cument X703 19921 Continuation Sheet AIA Document G702T1992 Application and Certificate for Payment,or G732T"L2009,, APPLICATION.NO 3 Application and Certificate for.Payment,Gonstrt ction Manager as Adviser Edition, APPLICATION DATE 06-25-2013 , containing Contractor's signed certification is attached. In tabulations belo ,amounts:are in US dollars. P w ERIOD T0: f3f�B13'. Use Column 11 on Contracts:where variable retainage for line items may apply. ARCHITEC'T'S PROJECT-N0: 561-13 age: o A B C' . D E F, G. LI I WORK COMPLETED . MATERIALS' TOTAL BALANCE TO: ITEM SCHEDULED PRESENTLY COMPLETED AND % RETAINAGE NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS FINISH." STORED STORED TO DATE (G-C) 1 variable rate APPLICATION THIS PERIOD (f ) Ij+E (Not in D or E) (D+E+F),` . (C-.G)' eneral Conditions, 6;500.00 6;175.00 325.00 6,500.00: 100.00 325.00 , 0and 75 7,500.00 " 7,500.00 100. 0 375.00 obilization 2;500.00 1,875.00 625.00 2,500.00 100.00 1.25.00 etrofit T2 aterial 7,500.00 7,500.00 7,500.00 100.00 375.00 Labor 30,000.00; 27,000.00 3,000,00 30,000.00; 100;00 1,500.00 . Retrofit T3 Material 4,000.00 4,000.00 4,000.00 100.00 200.00 .abor : 12,000 00 7,800.00., 4,200.00 12,000.00 100.00 600.00 .etrofit T4 aterial 3;000.00 3,000.00:, ...' : 3,000,00 100.00 150.00 a66r 9,000.00 o 91000.00 9,000.00 100.00 450.00 Ali Totals: 82,0.00.00 73,850.00 8,150;00 82,000.00 100 00;: 4,100.00 ----------- GRAND TOTAL CAUTION:you should sign an original AIA Contract.Document,on which this text appears in ICED.An.original assures that cltanges will not be obscured. AIA Document G703TM—1992.Copyright @ 1963,1965,1966,1967;1970,1978,1983 and 1992 by The American.Institute of Architects.All rights reserved.WARNING;This AIA Document is protected by D.S.Copyright Law and international Treaties.Unauthorized reproduction or distribution of this Al. 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 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. Attachment D.1 SHIEL SEXTON COMPANY INTERIM WAIVER AND RELEASE OF LIENS AND CLAIMS UPON PAYMENT STATE OF COUNTY OF jr- Whereas, LENEX STEEL COMPANY ("Subcontractor")who has furnished certain materials, equipment, services, and/or labor pursuant to a subcontract agreement or purchase order with SHIEL SEXTON COMPANY("Contractor")for the project known as SSC/ SHREWSBERRY WISHARD CHC 38TH ST.("Project"),which is located at, , IN (collectively referred to as the"Property"), and is owned by ("Owner"). Upon receipt of the sum of$ I I I ��S [insert sum requested in current pay application] ("Current Payment"), the Subcontractor waives and releases any and all liens or claims of liens and all claims,demands, actions, causes of action or other rights against the Cootr ,ctor, Owner and the Property or any right against any labor and/or material payment bond it has or may have through the date of 20__a, [insert last date of work performed that corresponds to Current Payment] ("Current Date') and reserving those r ghts and liens that the Subcontractor might have in any retainage on account of materials, equipment, services and/or labor furnished by the undersigned to or on account of the Contractor. Further, the Subcontractor covenants and agrees to apply sums received as the Current Payment first, and in no event later than 15 days after the receipt of the Current Payment,to pay all employees, laborers, materialmen, sub-subcontractors and sub-subconsultants employed by the undersigned in connection with the Project and all bills.or indebtedness incurred through the Current Date for materials, equipment, services, and/or labor and taxes, furnished by such parties to the undersigned in connection with the execution of the Subcontractor's work on the Project. The Subcontractor further represents that all employees, laborers, materialme.n, subcontractors and su consultants employed by the Subcontractor in connection with the Project and all bills incurred through 1��,�(� 20L , [insert the last date of work performed that corresponds to the last pay application] for materials, equipment, services and/or labor, and taxes, furnished by such parties to the Subcontractor in connection with the execution of the Subcontractor's work on the Project, have been fully paid and that no obligation, legal, equitable or otherwise, are owed by the Subcontractor to such parties. Subcontractor further agrees to indemnify, defend and hold harmless the Owner and the Contractor for and against any and all liabilities, losses, costs, expenses and fees, including reasonable attorney's fees and court costs by reason of claims or liens for any labor, materials or services furnished for the Project. The Subcontractor acknowledges that this Waiver and Release is given to induce the payment recited above, and that this Waiver and Release is in substantial conformance with the requirements of applicable law. The undersigned executing this Waiver and Release hereby represents and warrants that he/she has full power and authority to bind the Subcontractor to the terms hereof. Applicable to Payment Request(s) No 3 (or) Invoice(s) No. Given under hand and seal this 2' day of (�(��', 20/ 9 Company LENEX STEEL COMPANY Signed r�� : iL4 (SEAL) By: Ar%t 4 Cn 11 to Title C-, ��r,aAC-ie SUBSCRIBED AND SWORN TO before me this day of 04 My commission expires ..:ua uar+a:.maasa�vaausvy^��.:rtassa,�.awwwi:m!n_�c_Yt:.,ct � �/w' — � � �✓Y" :eta;nab; TAMMY G..DEA o ary Publi Marion Counts s a 1.1y Commission Expire i July 27,2016 Subcontract#; 200-0007 902 N. Capitol, Indianapolis, IN 46204 Page 47 of 52 phone: 317-423-6000 fax: 317-423-6300 Prescribed by State 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 Le he��It d Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total I� 5 01 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. ll ALLOWED 20 �e n P IN SUM OF $ ON ACCOUNT OF APPROPRIATION FOR q02-1 4q W67 Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 3 0907 1 03500 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 7 22--2o/-3 gnature Title Cost distribution ledger classification if claim paid motor vehicle highway fund