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224705 09/25/2013
CITY OF CARMEL, INDIANA VENDOR: 363794 Page 1 of 1 ONE CIVIC SQUARE GENERAL PIPING, INC CARMEL, INDIANA 46032 PO BOX 34367 CHECK AMOUNT: $6,727.48 INDIANAPOLIS IN 46234 CHECK NUMBER: 224705 CHECK DATE: 9/25/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 34 6, 727 . 48 DAL OF RETAINAGE v j: = nt- 732TM - 2009 ®cu�ne Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 84% APPLICATION NO:034 DISTRIBUTION TO: OWNER PERIOD TO:August 31,2013 CONSTRUCTION MANAGER FROM General Piping,Inc. VIA CONSTRUCTION Shiel Sexton CONTRACT DATE:June 11,2008 ARCHITECT CONTRACTOR: P.O.Box 34367 MANAGER: PROJECT NOS:NA/2829/NA CONTRACTOR Indianapolis,IN 46234 FIELD CONTRACT FOR: General Construction VIA ARCHITECT: CSO Architects OTHER CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous AIA Document G703TM,Continuation Sheet,is attached. Certificates for Payment were issued and payments received from the Owner,and that current payment 1. ORIGINAL CONTRACT SUM ....................................................................... $ 3,492,504.00 shown herein is now due. 2. NET CHANGES IN THE WORK.................................................................. $ 146,505.46 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I t 2) ..............................................$ 3,639,009.46 By: Date: tember 03 2013 4. TOTAL COMPLETED AND STORED TO DATE(Column G on G703).... $ 3,639,009.46 State of: Indiana a 5. RETAINAGE: County of:Hendricks r� a. 0 %of Completed Work Subscribed and sworn to before 9` lr� Ve (Column D+E on G703) $ 0.00 me this 3 day of � 2p 13 s b. 0 %of Stored Material Notary Public:Luke Roseboom� �441 (Column Fon G703) $ 0.00 My Commission ex ires:July 07,2020 fr Total Retainage(Lines 5a+5b,or Total in Column 1 on G703)............. $ o.00 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE .................................................... $ 3,639,009.46 In accordance with the Contract Documents,based on evaluations of the Work and the data sing (Line 4 minus Line 5 Total) this application,the Construction Manager and Architect certify to the Owner that to the best o their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ................................ $ 3,613,009.46 knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Docu t a d the C tractor is entitled to payment of the AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE ............................................................ $ 26,000.0 AMOUNT CERTIFIED... ... ... . ....... $ 26,000.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 minus Line 6) $ 0.00 CONSTRUCTION MANAGER: By: Date: SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS ARCHITECT:(NOT Z.-If ultiple Prime Contractors are responsible forperformin portio s of the Project, the Architect's Certifica - n is not required.) �f Total changes approved in previous months by Owner$ 331,444.60$ 140,235.60 By: Date: Total approved this month including Construction $ 0.00$ 44,703.54 Change Directives This Ce to is not ne a 1 .The OUNT CERTIFIED is payable only to the Contractor named TOTALS $ 331,444.60$ 184,939.14 herein. Issuance,payment and ac nce of payment are without prejudice to any rights of the Owner NET CHANGES IN THE WORK $ 146,505.46 or Contractor under this Contract. AIA Document G732-—2009(formerly 13702TMCMa—1992).Copyright©1992 and 2009 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.This document was produced by AIA software at 09:42:20 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1148807282) c_ ® ii :� T ® 1 li ®c ent X703 M Continuation Sheet AIA Document,G702TM_I992,Application and Certification for Payment,or G736Tm-2009, APPLICATION NO:034 Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE: containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:NA A B C D I E F G H I WORK COMPLETED TOTAL FROM MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE THIS PERIOD APPLICATION DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) I Bond 27,350.00 27,350.00 0.00 0.00 27,350.00 100.00% 0.00 0.00 Supervision/PM/Gen. 2 Cond. 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 3 Labor 181,855.00 181,855.00 0.00 0.00 181,855.00 100.00% 0.00 0.00 4 Material 72,013.00 72,013.00 0.00 0.00 - 72,013.00 100.00% 0.00 0.00 5 Submittals 21,869.00 21,869.00 0.00 0.00 21,869.00 100.00% 0.00 0.00 6 Punchlist 12,000.00 12,000.00 0.00 0.00 12,000.00 100.00% 0.00 0.00 7 Closeout 6,000.00 0.00 6,000.00 0.00 6,000.00 100.00% 0.00 0.00 3D 8 CAD/Coordination 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 9 Labor 34,726.00 34,726.00 0.00 0.00 34,726.00 100.00%1 0.00 0.00 10 Material 64,200.00 64,200.00 0.00 0.00 64,200.00 100.00%1 0.00 0.00 11 Daily Clean-up 15,000.00 15,000.00 0.00 0.00 15,000.00 100.00% 0.00 0.00 AW#8-Plumbing 12 (4290A) 15,113.00 0.00 15,113.00 0.00 15,113.00 100.00% 0.00 0.00 AW#9-Water/Gas 13 (4290B) 17,214.54 0.00 17,214.54 0.00 17,214.54 100.00% 0.00 0.00 AW#10 Hyd. 14 (4300A) 1,926.00 0.00 1,926.00 0.00 1,926.00 100.00% 0.00 0.00 15 AW#16 CAD(4290) 450.00 0.00 450.00 0.00 450.00 100.00% 0.00 0.00 16 AW#16 CAD(4300) 10,000.00 0.00 10,000.00 0.00 10,000.00 100.00% 0.00 0.00 17 Mechanical ID 0.00 0.00 0.00 0.00 0.00 0.00% 0.001 0.00 L1,8 Labor 5,100.00 5,100.00 0.00 0.00 5,100.00 100.00% 0.00 0.00 9 Material 5,100.00 5,100, 0 0.001 0.001 5,100.00 100.00-/,,L 0.001 0.00 AIA Document G703° -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 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.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE THIS PERIOD APPLICATION DATE (G . C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) 20 Firestopping 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 21 Labor 5,350.00 5,350.00 0.00 0.00 5,350.00 100.00% 0.00 0.00 22 Material 5,939.00 5,939.00 0.00 0.00 5,939.00 100.00% 0.00 0.00 23 Housekeeping Pads 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 24 Labor 1,411.00 1,411.00 0.00 0.00 1,411.00 100.00%1 0.00 0.00 25 Material 2,676.00 2,676.00 0.00 0.00 2,676.00 100.00%1 0.00 0.00 26 Painting 3,000.00 3,000.00 0.00 0.00 3,000.00 100.00%1 0.00 0.00 Sleeves/Core Drill 27 Holes 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 28 Labor 19,200.00 19,200.00 0.00 0.00 19,200.00 100.00% 0.00 0.00 29 Material 31,800.00 31,800.00 0.00 0.00 31,800.00 100.00% 0.00 0.00 30 Grease Interceptor 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 31 Labor 3,360.00 3,360.00 0.00 0.00 3,360.00 100.00% 0.00 0.00 32 Material 16,830.00 16,830.00 0.00 0.00 16,830.00 100.00%1 -0.00 0.00 33 Cranes and Lifts 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00%1 0.00 0.00 34 JUnderground WN 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 35 Labor 28,186.00 28,186.00 0.00 0.00 28,186.00 100.00% 0.00 0.00 36 Material 35,120.00 35,120.00 0.00 0.00 35,120.00 100.00% 0.00 0.00 37 Underground Storm 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 38 Labor 6,303.00 6,303.00 0.00 0.00 6,303.00 100.00%1 0.00 0.00 39 Material 10,637.00 10,637.00 0.00 0.00 10,637.00 100.00% 0.00 0.00 40 Underslab Drainage 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 41 Labor 9,500.00 9,500.00 0.00 0.00 9,500.00 100.00% 0.00 0.00 42 Material 1,714.00 1,714.00 0.00 0.00 1,714.00 100.00% 0.00 0.00 Aboveground WN 43 (M) 165,426.00 165,426.00 0.00 0.00 165,426.00 100.00%. 0.00 0.00 Aboveground WN 44 L 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 45 113asernent 33,050.00 33,050.00 0.00 0.001 33,050.00 100.00% 0.00 0.00 AIA Document G703T -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 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 2 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED H /O TOTAL FROM MATERIALS COMPLETED e BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS ITEM DESCRIPTION OF SCHEDULED FROM AND STORED TO FINISH (IF VARIABLE STORED APPLICATION THIS PERIOD DATE (G-C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) 46 Plenum 17,879.00 17,879.00 0.00 0.00 17,879.00 100.00% 0.00 0.00 47 Orchestra 22,368.00 22,368.00 0.00 0.00 22,368.00 100.00% 0.00 0.00 48 Box Tier 18,144.00 18,144.00 0.00 0.00 18,144.00 100.00% 0.00 0.00 49 Balcony 18,409.00 18,409.00 0.00 0.00 18,409.00 100.00% 0.00 0.00 50 lAttic 7,121.00 7,121.00 0.00 0.00 7,121.00 100.00%1 0.00 0.00 Aboveground Storm 51 M) 67,165.00 67,165.00 0.00 0.00 67,165.00 100.00% 0.00 0.00 Aboveground WN (L) Aboveground Storm 52 L 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 53 Basement 6,120.00 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 0.00 54 11plenurn 365.00 365.00 0.00 0.00 365.00 100.00% 0.00 0.00 55 Orchestra 7,856.00 7,856.00 0.00 0.00 7,856.00 100.00% 0.00 0.00 56 Box Tier 3,665.00 3,665.00 0.00 0.00 3,665.00 100.00%1 0.00 0.00 57 Balcony 15,976.00 15,976.00 0.00 0.00 15,976.00 100.00%1 0.00 0.00 58 Attic 9,667.00 9,667.00 0.00 0.00 9,667.00 100.00% 0.00 0.00 59 Force Main 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 60 Labor 7,546.00 7,546.00 0.00 0.00 7,546.00 100.00% 0.00 0.00 61 Material 27,882.00 27,882.00 0.00 0.00 27,882.00 100.00% 0.00 0.00 68 Domestic Water(M) 184,831.00 184,831.00 0.00 0.00 184,831.00 100.00%1 0.00 0.00 69 Domestic Water L 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 70 113asement 85,091.00 85,091.00 0.00 0.00 85,091.00 100.00% 0.00 0.00 71 Plenum 19,393.00 19,393.00 0.00 0.00 19,393.00 100.00% 0.00 0.00 72 Orchestra 26,728.00 26,728.00 0.00 0.00 26,728.00 100.00% 0.00 0.00 73 Box Tier 18,955.00 18,955.00 0.00 0.00 18,955.00 100.00%1 0.00 0.00 74 Balcony 17,692.00 17,692.00 0.001 0.00 17,692.00 100.00% 0.00 0.00 75 Attic 823.00 823.00 0.001 0.00 823.00 100.00% 0.00 0.00 76 Incoming Dom. 0.00 0.00 0.001 0.00 0.00 0.00% 0.00 0.00 AIA Document G703--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 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 3 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) Water Service 77 Labor 6,864.00 6,864.00 0.00 0.00 6,864.00 100.00% 0.00 0.00 78 Material 7,163.00 7,163.00 0.00 0.00 7,163.00 100.00% 0.00 0.00 79 Drains/Cleanouts(M) 25,175.00 25,175.00 0.00 0.00 25,175.00 100.00% 0.00 0.00 80 Drains/Cleanouts(L) 0.00 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00 81 Basement 21,076.00 21,076.00 0.00 0.00 21,076.00 100.00% 0.00 0.00 82 Plenum 1,920.00 1,920.00 0.00 0.00 1,920.00 100.00% 0.00 0.00 83 Orchestra 1,320.00 1,320.00 0.00 0.00 1,320.00 100.00% - 0.00 0.00 84 Box Tier 3,120.00 3,120.00 0.00 0.00 3,120.00 100.00% 0.00 0.00 85 Balcony 2,400.00 2,400.00 0.00 0.00 2,400.00 100.00%1 0.00 0.00 86 Attic 3,720.00 3,720.00 0.00 0.00 3,720.00 100.00% 0.00 0.00 87 Carriers(M) 12,347.00 12,347.00 0.00 0.00 12,347.00 100.00% 0.00 0.00 88 Carriers L 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 89 Basement 1,200.00 1,200.00 0.00 0.00 1,200.00 100.00% 0.00 0.00 90 Plenum 6,750.00 6,750.00 0.00 0.00 6,750.00 100.00%1 0.00 0.00 91 Orchestra 2,100.00 2,100.00 0.00 0.00 2,100.00 100.00% 0.00 0.00 92 Box Tier 4,500.00 4,500.00 0.00 0.00 4,500.00 100.00% 0.00 0.00 93 Balcony 3,000.00 3,000.00 0.00 0.00 3,000.00 100.00% 0.00 0.00 94 Attic 300.00 300.00 0.00 0.00 300.00 100.00% 0.00 0.00 Gas Pressure 95 Regulator 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 96 Labor 480.00 480.00 0.00 0.00 480.00 100.00% 0.00 0.00 97 Material 277.00 277.00 0.00 0.00 277.00 100.00% 0.00 0.00 98 Gas Piping 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 99 Labor 2,858.00 2,858.00 0.00 0.00 2,858.00 100.00% 0.00 0.00 100 Material 1,220.00 1,220.00 0.00 0.00 1,220.00 100.00% 0.00 0.00 P-811 Kitchen Connections 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 0.00 Water Softener 0.00 0400 0.00 0.00 0.00 0.00% 0.00 0.00 AIA Document G7031-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIO 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 4 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE APPLICATION DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) 109 Labor 2,400.00 2,400.00 0.00 0.00 2,400.00 100.00% 0.00 0.00 110 Material 1,453.00 1,453.00 0.00 0.00 1,453.00 100.00% 0.00 0.00 Thermostatic Mixing 111 Valves 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 112 Labor 840.00 840.00 0.00 0.00 840.00 100.00%, 0.00 0.00 113 Material 1,159.00 1,159.00 0.00 0.00 1,159.00 100.00% 0.00 0.00 114 Backflow Preventers 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 115 Labor 1,920.00 1,920.00 0.00 0.00 1,920.00 100.00% 0.00 0.00 116 Material 4,337.00 4,337.00 0.00 0.00 4,337.00 100.00% 0.00 0.00 117 Vibration Isolation 29,532.00 29,532.00 0.00 0.00 29,532.00 100.00%1 0.00 0.00 Condensate Piping 118 (M) 1,608.00 1,608.00 0.00 0.00 1,608.00 100.00% 0.00 0.00 Condensate Piping 119 L 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 120 Basement 8,592.00 8,592.00 0.00 0.00 8,592.00 100.00% 0.00 0.00 121 Orchestra 928.00 928.00 0.00 0.00 928.00 100.00%1 0.00 0.00 122 Box Tier 353.00 353.00 0.00 0.00 353.00 100.00% 0.00 0.00 123 H dronic Piping(M) 197,044.00 197,044.00 0.00 0.00 197,044.00 100.00% 0.00 0.00 124 Hydronic Piping(L) 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 125 Basement 90,564.00 90,564.00 0.00 0.00 90,564.00 100.00% 0.00 0.00 126 Plenum 14,180.00 14,180.00 0.00 0.00 14,180.00 100.00%1 0.00 0.00 127 Orchestra 26,716.00 26,716.00 0.00 0.00 26,716.00 100.00%1 0.00 0.00 128 Box Tier 25,375.00 25,375.00 0.00 0.00 25,375.00 100.00% 0.00 0.00 129 Balcony 43,190.00 43,190.00 0.00 0.00 43,190.00 100.00% 0.00 0.00 130 Attic 13,309.00 13,309.00 0.00 0.00 13,309.00 100.00% 0.00 0.00 131 Anchors and Guides 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 132 Labor 2,880.00 2,880.00 0.00 0.00 2,880.00 100.00% 0.001 0.00 133 Material 1,834.00 1,834.00 0.00 0.00 1,834.00 100.00% 0.00 0.00 134 IMiscellaneous 79,294.001 79,294.00 0.00 0.001 79,294.00 100.00% 0.001 0.00 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 A10 Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIAe Document,or any portion of It,may result in severe civil and criminal penalties,and will be prosecuted to 5 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE APPLICATION DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) Supports 135 H dronic Specialties 77,660.00 77,660.00 0.00 0.00 77,660.00 100.00% 0.00 0.00 139 Water Treatment 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 140 Labor 600.00 600.00 0.00 0.00 600.00 100.00% 0.00 0.00 141 Material 3,132.00 3,132.00 0.00 0.00 3,132.00 100.00%1 0.00 0.00 Riggin/Offloading 143 HVAC Equipment 3,840.00 3,840.00 0.00 0.00 3,840.00 100.00% 0.00 0.00 144 AHU Connections 55,320.00 55,320.00 0.00 0.00 55,320.00 100.00% 0.00 0.00 Duct Heating Coil 145 Connections 1,260.00 1,260.00 0.00 0.00 1,260.00 100.00% 0.00 0.00 VAV Connections- 146 Basement 8,285.00 8,285.00 0.00 0.00 8,285.00 100.00% 0.00 0.00 VAV Connections- 147 Plenum 1,763.00 1,763.00 0.00 0.00 1,763.00 100.00% 0.00 0.00 VAV Connections- 148 Orchestra 1,586.00 1,586.00 0.00 0.00 1,586.00 100.00% 0.00 0.00 VAV Connections- 149 Box Tier 4,231.00 4,231.00 0.00 0.00 4,231.00 100.00% 0.00 0.00 VAV Connections- 150 Balcony 3,173.00 3,173.00 0.00 0.00 3,173.00 100.00%1 0.00 0.00 VAV Connections- 151 Attic 2,820.00 2,820.00 0.00 0.00 2,820.00 100.00% 0.00 0.00 Unit Heater Connections- 152 Basement 428.00 428.00 0.00 0.00 428.00 100.00% 0.00 0.00 Unit Heater Connections- 154 Orchestra 215.00 215.00 0.00 0.00 215.00 100.00% 0.00 0.00 Unit Heater Connections-Box 155 Tier 107.00 107.00 0.00 0.00 107.00 100.00% 0.00 0.00 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 A10 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 s the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05113/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO (G-- C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) FCU Connections- 156 Basement 2,057.00 2,057.00 0.00 0.00 2,057.00 100.00% 0.00 0.00 FCU Connections- 157 Orchestra 1,028.00 1,028.00 0.00 0.00 1,028.00 100.00% 0.00 0.00 FCU Connections- 158 Box Tier 515.00 515.00 0.00 0.00 515.00 100.00%1 0.00 0.00 159 Radiant Floor System 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 160 Labor 20,483.00 20,483.00 0.00 0.00 20,483.00 100.00% 0.00 0.00 161 Material 11,816.00 11,816.00 0.00 0.00 11,816.00 100.00% 0.00 0.00 Humidifier 162 Connections 15,360.00 15,360.00 0.00 0.00 15,360.00 100.00% 0.00 0.00 FTR Connections- 163 Basement 664.00 664.00 0.00 0.00 664.00 100.00% 0.00 0.00 FTR Connections- 164 Plenum 2,656.00 2,656.00 0.00 0.00 2,656.00 100.00% 0.00 0.00 FTR Connections- 165 Orchestra 14,605.00 14,605.00 0.00 0.00 14,605.00 100.00% 0.00 0.00 FTR Connections- 166 Box Tier 6,307.00 6,307.00 0.00 0.00 6,307.00 100.00% 0.00 0.00 FTR Connections- 167 Balcony 9,958.00 9,958.00 0.00 0.00 9,958.00 100.00%1 0.00 0.00 FTR Connections- 168 Attic 1,992.00 1,992.00 0.00 0.00 1,992.00 100.00% 0.00 0.00 169 Insulation-Basement 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 170 Labor 31,937.00 31,937.00 0.00 0.00 31,937.00 100.00% 0.00 0.00 171 Material 27,208.00 27,208.00 0.00 0.00 27,208.00 100.00% 0.00 0.00 172 Insulation-Plenum 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 173 Labor 18,103.00 18,103.00 0.00 0.00 18,103.00 100.00% 0.00 0.00 174 Material 15,423.00 15,423.00 0.00 0.00 15,423.00 100.00% 0.00 0.00 175 Insulation-Orchestra 0.00 0.00 0.00 0.00 0.001 0.00% 0.00 0.00 176 Labor 14,914.001 14,914.00 0.00 0.001 14,914.001 100.00%1 0.00 0.00 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 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 7 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A ) B C D I E F G H I WORK COMPLETED TOTAL FROM MATERIALS COMPLETED o/o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO (G-- C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) 177 IMaterial 12,706.00 12,706.00 0.00 0.00 12,706.00 100.00% 0.00 0.00 178 Insulation-Box Tier 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 179 Labor 13,835.00 13,835.00 0.00 0.00 13,835.00 100.00% 0.00 0.00 180 IMaterial 11,786.00 11,786.00 0.00 0.00 11,786.00 100.00% 0.00 0.00 181 Insulation-Balcony 0.00 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00 182 Labor 13,835.00 13,835.00 0.00 0.00 13,835.00 100.00%1 0.00 0.00 183 Material 11,786.00 11,786.00 0.00 0.00 11,786.00 100.00% 0.00 0.00 184 Insulation-Attic 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 185 1 Labor 13,835.00 13,835.00 0.00 0.00 13,835.00 100.00% 0.00 0.00 186 Material 11,786.00 11,786.00 0.00 0.00 11,786.00 100.00% 0.00 0.00 Temp.Controls- 187 Engineering 64,446.00 64,446.00 0.00 0.00 64,446.00 100.00% 0.00 0.00 Temp.Controls- 188 Basement 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 189 Labor 83,003.00 83,003.00 0.00 0.00 83,003.00 100.00 0/6' 0.00 0.00 190 Material 151,376.00 151,376.00 0.00 0.00 151,376.00 100.00% 0.00 0.00 Temp.Controls- 191 Plenum 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 192 Labor 51,877.00 51,877.00 0.00 0.00 51,877.00 100.00% 0.00 0.00 193 Material 78,178.00 78,178.00 0.00 0.00 78,178.00 100.00% 0.00 Temp.Controls- 194 Orchestra 0.00 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00 195 Labor 15,563.00 15,563.00 0.00 0.00 15,563.00 100.00% 0.00 0.00 196 Material 25,508.00 25,508.00 0.00 0.00 25,508.00 100.00% 0.00 0.00 Temp.Controls-Box 197 Tier 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 198 Labor 15,563.00 15,563.00 0.00 0.00 15,563.00 100.00% 0.001 0.00 199 Material 25,508.00 25,508.00 0.00 0.00 25,508.00 100.00% 0.001 0.00 200 Temp.Controls- 0.001 0.001 0.001 0.001 0.00 0.00% 0.001 0.00 AIA Document G703--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 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 8 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (G . C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) _ Balcony 201 Labor 15,563.00 15,563.00 0.00 0.00 15,563.00 100.00%1 0.00 0.00 202 Material 22,701.00 22,701.00 0.00 0.00 22,701.00 100.00%1 0.00 0.00 Temp.Controls- 203 Attic 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 204 Labor 15,563.00 15,563.00 0.00 0.00 15,563.00 100.00% 0.00 0.00 205 Material 16,170.00 16,170.00 0.00 0.00 16,170.00 100.00% 0.00 0.00 206 Test and Balance 19,474.00 19,474.00 0.00 0.00 19,474.00 100.00% 0.00 0.00 CO#1 -GPI#2- 207 Leach/Russel -24,090.00 -24,090.00 0.00 0.00 -24,090.00 100.00% 0.00 0.00 CO#2-GPI#3-ASI 208 #18 1,776.00 1,776.00 0.00 0.00 1,776.00 100.00% 0.00 0.00 GPI#6-Triplex 209 Sump Basin 61,694.00 61,694.00 0.00 0.00 61,694.00 100.00% 0.00 0.00 GPI#7A-Basement 210 Kitchen Revisions 17,328.00 17,328.00 0.00 0.00 17,328.00 100.00% 0.00 0.00 GPI#10-Box Tier 211 Catering Kitchen 85,312.00 85,312.00 0.00 0.00 85,312.00 100.00% 0.00 0.00 AW 430OA-001 - 213 F#15 7,277.00 7,277.00 0.00 0.00 7,277.00 100.00%1 0.00 0.00 AW 430OA-002- 214 F#18 8,605.00 8,605.00 0.00 0.00 8,605.00 100.00% 0.00 0.00 215 AW 4290A-001 -17#5 1,392.00 1,392.00 0.00 0.00 1,392.00 100.00%1 0.00 0.00 216 AW 4290A-003-17#8 1,372.00 1,372.00 0.00 0.00 1,372.00 100.00% 0.00 0.00 217 AW 4290A-002-F#9 1,845.00 1,845.00 0.00 0.00 1,845.00 100.00% 0.00 0.00 AW 4290B-001 - 218 17#19 8,044.00 8,044.00 0.00 0.00 8,044.00 100.00% 0.00 0.00 AW 4290A-004- 219 F#23A 5,361.00 5,361.00 0.00 0.00 5,361.00 100.00% 0.00 0.00 AW 4290B- 220 Water/Sewer Bills 22,218.46 22,218.46 0.001 0.001 22,218.46 100.00%1 0.00 0.00 AIA Document G7031-1992.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 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 9 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D I E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) AW 430OA-005- 221 F#27 21,740.00 21,740.00 0.00 0.00 21,740.00 100.00% 0.00 0.00 AW 430OA-003- 222 F#24 5,023.00 5,023.00 0.00 0.00 5,023.00 100.00% 0.00 0.00 AW 4290A-005- 223 F#28 6,928.00 6,928.00 0.00 0.00 6,928.00 100.00% 0.00 0.00 AW 430OA-006- 224 F#25 10,104.00 10,104.00 0.00 0.00 10,104.00 100.00% 0.00 0.00 GPI#22-Crossover 225 Bride 17,5.33.00 17,533.00 0.00 0.00 17,533.00 100.00% 0.00 0.00 226 AW 4300A-11 -F#45 579.00 579.00 0.00 0.00 579.00 100.00% 0.00 0.00 227 AW 4300A-10-F#43 6,563.00 6,563.00 0.00 0.00 6,563.00 100.00% 0.00 0.00 AW 4290A-008- 228 F#41 5,933.00 5,933.00 0.00 0.00 5,933.00 100.00% 0.00 0.00 CO#8-GPI#30- 229 Lift Station Slab 7,946.00 7,946.00 0.00 0.00 7,946.00 100.00%1 0.00 0.00 AW 430OA-013- 230 F#58 4,521.00 4,521.00 0.00 0.00 4,521.00 100.00% 0.00 0.00 AW 430OA-012- 231 F#48 2,937.00 2,937.00 0.00 0.00 2,937.00 100.00% 0.00 0.00 AW 4290A-009- 232 F#57 -1,105.00 -1,105.00 0.00 0.00 -1,105.00 100.00% 0.00 0.00 AW 4290A-007- 233 F#36 1,653.00 1,653.00 0.00 0.00 1,653.00 100.00% 0.00 0.00 AW 430OA-009- 234 JF#17 2,376.00 2,376.00 0.00 0.00 2,376.00 100.00% 0.00 0.00 CO#10-GPI#50- 235 AST 104 40,550.00 40,550.00 0.00 0.00 40,550.00 100.00% 0.00 0.00 AW 430OA-014- 236 17#66 3,304.00 3,304.00 0.00 0.00 3,304.00 100.00% 0.00 0.00 AW 430OA-015- 237 JF#65 1 2,995.00 2,995.001 0.001 0.001 2,995.00 100.00% 0.00 0.00 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 U.S. Copyright Law and Intemational 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 10 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE APPLICATION DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) AW 4290A-012- 238 F#82 4,791.00 4,791.00 0.00 0.00 4,791.00 100.00% 0.00 0.00 AW 4290A-011 - 239 F#13 182.00 182.00 0.00 0.00 182.00 100.00% 0.00 0.00 AW 430OA-019- 240 F#47 1,761.00 1,761.00 0.00 0.00 1,761.00 100.00%1 0.00 0.00 AW 4290B-013 - 241 JF#91 4,132.00 4,132.00 0.00 0.00 4,132.00 100.00% 0.00 0.00 AW 4290B-014- 242 F#93 12,460.00 12,460.00 0.00 0.00 12,460.00 100.00% 0.00 0.00 AW 4290B-015 - 243 F#101 3,759.00 3,759.00 0.00 0.00 3,759.00 100.00%1 0.00 0.00 AW 430OA-025- 244 JF#59 1,594.00 1,594.00 0.00 0.00 1,594.00 100.00% 0.00 0.00 AW 430OA-026- 245 F#102 450.00 450.00 0.00 0.00 450.00 100.00% 0.00 0.00 AW 4290A-017- 246 F#67 5,500.00 5,500.00 0.00 0.00 5,500.00 100.00%1 0.00 0.00 247 AW-4290A 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 CO#6-Reduce 248 AW429A$50,000 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 CO#9-Reduce 249 AW429B$20,000 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 CO#I I -Reduce 250 AW429013$50,000 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 251 ICO#12-Settlement 90,000.00 90,000.00 0.00 0.00 90,000.00 100.00% 0.00 0.00 AW 4290A-013- 252 F#100 Ddct from B) 1,873.00 1,873.00 0.00 0.00 1,873.00 100.00% 0.00 0.00 AW 4290A-016- F#96(Deduct from 253 B) 1 1,603.001 1,603.00 0.00 0.00 1,603.00 100.00% 0.0ol 0.00 254 AW 4290A-018- 1 13,587.001 13,587.00 0.00 0.00 13,587.00 100.00%o 0.00 0.00 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 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.This document was produced by AIA software at 09:40:35 on 09/0312013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) A B C D I E F G H I WORK COMPLETED TOTAL /o FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) F#86,87(Ddct frm B) AW 4290A-019- F#14(Deduct from 255 B) 1,304.00 1,304.00 0.00 0.00 1,304.00 100.00% 0.00 0.00 AW 430OA-008- 256 F#44 770.00 770.00 0.00 0.00 770.00 100.00%1 0.00 0.00 AW 430OA-010- 257 F#43 -58.00 -58.00 0.00 0.00 -58.00 100.00% 0.00 0.00 AW 4290C-001 - 258 F#42 2,345.00 2,345.00 0.00 0.00 2,345.00 100.00% 0.00 0.00 AW 4290C-002 - 259 JF#54 7,205.00 7,205.00 0.00 0.00 7,205.00 100.00% 0.00 0.00 AW 4290A-014- 260 F#98(Ddct from B) 2,672.00 2,672.00 0.00 0.00 2,672.00 100.00% 0.00 0.00 AW 4290A-015- 261 F#89(Ddct from B) 1,133.00 1,133.00 0.00 0.00 1,133.00 100.00% 0.00 0.00 AW 4290A-020- 262 JF#108 1,035.00 1,035.00 0.00 0.00 1,035.00 100.00% 0.00 0.00 263 lRemo ve Allowance -44,703.54 0.00 -44,703.54 0.00 -44,703.54 100.00%1 0.00 0.00 GRAND TOTAL $3,639,009.46 $3,633,009.46 $6,000.00 $0.00 $3,639,009.46 100.00%1 $0.001 $0.00 AIA Document G703' -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 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 12 the maximum extent possible under the law.This document was produced by AIA software at 09:40:35 on 09/03/2013 under Order No.4363654631_1 which expires on 05/13/2014,and is not for resale. User Notes: (1866744665) CONSENT TO FINAL PAYMENT BY OHIO FARMERS INSURANCE COMPANY OHIO FARMERS INSURANCE COMPANY BOND NO. 0051795 TO OBLIGEE OBLIGEE'S PROJECT NO.: City of Carmel Redevelopment Commission One Civic Square DATE OF CONTRACT: June 11,2008 Carmel,IN 46032 PROJECT: (Insert name, address and description of Project) Parcel 7A.Regional Performing Arts Center-Interior Rough Construction Pkg P4 Bid Pkg#4300 HVAC:Piping&Plumbing According to the provisions of the Contract between the Obligee and the Contractor as indicated above, Ohio Farmers Insurance Company, P. O. Box 5001, One Park Circle, Westfield Center, Ohio 44251- 5001, as Surety on bond of contractor, (Insert name and address of Contractor) General Piping Inc. 1175 Western Drive Indianapoiis.IN 46241 hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve Ohio Farmers Insurance Company of any of its obligations to the Obligee, (Insert name and address of Obligee) City of Carmel Redevelopment Commission One Civic Square Carmel, 46037 as stated in said Surety's bond. Dated: August 30, 2013 Ohio Farmers Insurance Company LohT6 M Adams THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME POWER#AND ISSUED PRIOR TO 09/29/10, FOR ANY PERSON OR PERSONS NAMED BELOW. General POWER NO. 1302892 04 Power 'Westfield Insurance Co. of Attorney Westfield National Insurance Co. CERTIFIED COPY Ohio Farmers Insurance Co. Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these presents make,constitute and appoint RICHARD A. BITTLES,MICHAEL C.CONOVER,HAROLD W.STARK, III, LORNA M.ADAMS,MARTHA L. DENTON,JOHN J. WIGGINS,JOHN R.PARMLEY,TERESA J.WILSON,MARILYN A.SHROUT,JOINTLY OR SEVERALLY of GREENCASTLE and State of IN its true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE,OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: 'Be It Resolved,that the President,any Senior Executive,any Secretary or any Fidelity&Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary." "Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting held on February 8,2000). In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and theif corporate seals to be hereto affixed this 29th day of SEPTEMBER A.D.,2010 � » Corporate +.• `S� �1 oNgL""', , WESTFIELD INSURANCE COMPANY seals !l� - Ae+ y �Py,......,�NS' �%$� Affixed OHIO FIARMERSIIONSURANCERCOMPA COMPANY ems:' SEAL "�;r1►bRTE Rfp 3 3 r! N ;rnc _o: :b- af e•� f Yom :. to; = 1848 By Slate of Ohio "°°""" *.' "' ", Dennis P. B-� aV National Surety Leader and County of Medina ss.: Senior Executive On this 29th day of SEPTEMBER A.D., 2010 ,before me personally came Dennis P. Baus to me known,who,being by me duly sworn, did depose and say, that he resides in Wooster, Ohio; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY,the companies described in and which executed the above instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were-so affixed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order. Notarial Seal Affixed Z:_, I .r William J. Kahelin, A rney at Law, Notary Public State of Ohio L;N ✓ �o My Commission Does Not Expire(Sec. 147.03 Ohio Revised Code) County of Medina ss.: iNI 4 ,c OFO 1, Frank A.Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect;and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 3 0 day of August A;�;; 2013 ii4A z SEAL z= cmss.GNARTERE�i� i fa% u~i SEAL me -e. Ca Secretary FYk =`'t' ;?o :;sb;• 1848 :$ •�, .. �: Frank A. Carrino, Secretary BPOAC2 (combined) (06-02) 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 TT �j e1 I fw,�, .L/7C, - Purchase Order No. �.' Rox Terms h JJdpd b �'j, Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1-3F 1 3 6 We o em /0 t 27 work 6'.. fedlAllio 17 Total 6 72-7 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 General f;/km T IN SUM OF $ P0. 13Qk 34367 ON ACCOUNT OF APPROPRIATION FOR r g02-114007 Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 3136 3 60�0� 6 �27.'�8 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 4"2013 Q- ,VA*XW �iN� Cost distribution ledger classification if Title claim paid motor vehicle highway fund