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Home My WebLink About246984 06/30/15 y'..�,A.+F CITY OF CARMEL, INDIANA VENDOR: 00350511 ® ONE CIVIC SQUARE SMOCK FANSLER CORP CHECK AMOUNT: $***304,860.00" ?a CARMEL, INDIANA 46032 2910 W MINNESOTA ST CHECK NUMBER: 246984 11i. �. INDIANAPOLIS IN 46241 CHECK DATE: 06/30/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460803 1 304,860.00 KESTNER 1 AIA Type Document Application and Certification for Payment Page 1 of 2 TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT:CARMEL REFLECTING POND APPLICATION NO: 1 DISTRIBUTION 30 W. MAIN ST. TO: SUITE 220 PERIOD 70:6/17/2015 _OWNER CARMEL, IN 46032 _ARCHITECT —CONTRACTOR FROM(CONTRACTOR): Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S 2910 W. Minnesota Street PROJECT NO: Indianapolis, IN 46241 A; 311? 2 CONTRACT FOR: CONTRACT DATE: The Undersigned Contractor certifies that to the best of the Contractor's knowledge, information and CONTRACTOR'S APPLICATION FOR PAYMENT belief the work covered by this application for Payment has been completed in accordance with the Application is made for Payment,as shown below, in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that current payment shown herein is now due. 1.ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . .$ 463,500.00 ----ti C l k F Smock anser Corporation 2. Net Change by Change Orders . . . . . . . . . . . . . . .$ 24,300.00 CONTRACTOR: 0�• �P...•••••.• C �, 2910 W. Minnesota Street Indianapolis, IN 46241 ` O 3.CONTRACT SUM TO DATE (Line 1 +2). . . . . . . . . . . $ 487,800.00 / 4.TOTAL COMPLETED AND STORED TO DATE . . . . . . $ 304,860.00 y , B Date: T.M. FANSLER / CEO 5. RETAINAGE: State of: IN a. 0.00%of Completed Work $ 0.00County of: �P b. 0.00%of Stored Material $ 0.00 Subscribed and MARION Sworn to before me this Day of irT EI 20pvP\\� Total retainage Line 5a+5b 0.00 Notary Public: My Commission Expires 6.TOTAL EARNED LESS RETAINAGE. . . . . . . . . . . . . . $ 304,860.00 (Line 4 less Line 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 com- prising the above application, the Architect certifies to owner that to the best of the Architect's (Line 6 from prior Certificate). . . . . . . . . . . . . . . . . . . . .$ 0.00 knowledge, information and belief the Work has progressed as indicated,the quality of the work 8.CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . .$ 304,860.00 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE (Line 3 less Line 6) $ '182,940.00 AMOUNT CERTIFIED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Attach explanation if amount certified differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.) Total changes approved in ARCHITECT: previous months by Owner 0.00 0.00 By. Date: Total approved this Month 39,300.00 -15,000.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, Payment and acceptance of payment are without prejudice to any TOTALS 39,300.00 -15,000.00 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 24,300.00 I AIA Type Document Application and Certification for Payment Page 2 of 2 TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT. CARMEL REFLECTING POND APPLICATION NO: 1 DISTRIBUTION 30 W. MAIN ST. TO: SUITE 220 PERIOD TO:6/17/2015 _OWNER CARMEL, IN 46032 _ARCHITECT CONTRACTOR FROM(CONTRACTOR): Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S 2910 W. Minnesota Street PROJECT NO: Indianapolis, IN 46241 CONTRACT FOR: CONTRACT DATE: SCHEDULE PREVIOUS COMPLETED STORED COMPLETED ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE 1 COPING STONES AND PAVER 386,300.00 0.00 251,095.00 0.00 251,095.00 65.00 135,205.00 0.00 LEVEING 2 UNDERDRAIN, 126,800.00 0.00 63,400.00 0.00 63,400.00 50.00 63,400.00 0.00 WATERPROOFING,TIE-IN 3 DEDUCT FOR MT.AIRY -49,600.00 0.00 -32,240.00 0.00 -32,240.00 65.00 -17,360.00 0.00 GRANITE 4 CHANGE ORDER#1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5 PRICE ADJUSTMENT TO 2015 16,150.00 0.00 16,150.00 0.00 16,150.00 100.00 0.00 0.00 RATES 6 REBUILT EAST EFFECTS 23,150.00 0.00 16,205.00 0.00 16,205.00 70.00 6,945.00 0.00 PLATFORM 7 SOUTH UNDERDRAIN -15,000.00 0.00 -9,750.00 0.00 -9,750.00 65.00 -5,250.00 0.00 DEDUCT/TIE-IN REPORT TOTALS $487,800.00 $0.00 $304,860.00 $0.00 $304,860.00 62.50 $182,940.00 $0.00 AFFIDAVIT AND WAIVER OF LIEN [ ] Final [X] Partial [X] Payment to Follow State of Indiana County of Marion T.M. Fansler , being duly sworn states that he is the CEO of SMOCK FANSLER CORP. having contracted with: Carmel Redevelopment Commission to furnish certain labor, materials, and/or services as follows: Misc. Construction for a project known as: SFC#15-015 Carmel Reflecting Pond located at Indianapolis, IN and does hereby state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the owner the sum of: ($304,860.00) Three Hundred Four Thousand Eight Hundred Sixty Dollars and No/100 [ ] receipt of which is hereby acknowledged; or [X] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due fi-om the owner is the sum of(50.00) [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon on account of Labor, Materials, and/or Services, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed, materials, or services furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SMOCK FANSLER CORP. By IZZ ` le CEO T.M. Fansler j oP`Ry°P,U► WITNESS MY HAND AND NOTARIAL SEAL, this 171' day of June ,2015. Melissa J. Bish p Nota r "Public = EXL My commission expires November 30, 2016 Residing in Morgan County i,gTF'OIF111►N��o` Prescribed by State Board of 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 S?11OC� ry �ansl�r Ccrpard�lOn Purchase Order No. 2�al� ' �In11CSo�d _sf Terms i4mkb -L' 131 T 6 _ ( Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) b-11-15 1 work oh re At f-IeA 49 541 30-4 964.° Total 50 gull 0. I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. , 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. 1 ALLOWED 20 Smirk P skr CorboraTlO�:, IN SUM OF $ Q-910 41 �(inneSofQ S+. Tna�an olis, T Af 4C14I� $ n ON ACCOUNT OF APPROPRIATION FOR ash � 2 /`�460�03 Board Members PO#or DEPT.r INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), 31713 gQ903 864 a° or 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 . eig at e Title Cost distribution ledger classification if claim paid motor vehicle highway fund