249031 08/26/15 c�q,f� CITY OF CARMEL, INDIANA VENDOR: 00350511
® i; ONE CIVIC SQUARE SMOCK FANSLER CORP CHECK AMOUNT: $***182,940.00*
r CARMEL, INDIANA 46032 2910 W MINNESOTA ST CHECK NUMBER: 249031
'Ml}�N-G�,` INDIANAPOLIS IN 46241 CHECK DATE: 08126/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460803 33127 2 182,940.00 CO FOR REFLECTING PON
AIA Type Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT: CARMEL REFLECTING POND APPLICATION NO: 2 DISTRIBUTION
30 W. MAIN ST. PERIOD 70:7/15/2015 TO:
SUITE 220 _OWNER
CARMEL, IN 46032 _ARCHITECT
—CONTRACTOR
FROM(CONTRACTOR): Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S
2910 W. Minnesota Street PROJECT NO:
Indianapolis, IN 46241 Pdr 3�/l93
CONTRACT FOR: CONTRACT DATE:
The Undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
CONTRACTOR'S APPLICATION FOR PAYMENT
belief the work covered by this application for Payment has been completed in accordance with the
Application is made for Payment,as shown below, in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner, and that
463,500.00 current payment shown herein is now due.
P Y
1.ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . .$ \;. Y P(�e
2
O .• •....,.�/
2.Net Change by Change Orders . . . . . . . . . . . . . . . .$ 24,300.00 CONTRACTOR. Smock Fansler Corporation C
2910 W. Minnesota Street Indianapolis, IN 46241 r
3.CONTRACT SUM TO DATE (Line 1 +2). . . . . . . . . . . $ 487,800.00Ar
,
4.TOTAL COMPLETED AND STORED TO DATE . . . . . . $ 487,800.00 ByDate: Xl�-AciEA�
T.M. FAr LER / CEO
5.RETAINAGE:
State of: IN
a. 0.00%of Completed Work $ 0.00 County of: MARION /'%iiTgTFOF
0
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me 4thisb Day of U 20
Notary Public:Total retainage(Line 5a+5b). . . . . . . . . . . . . . . . . . . . $ 0.00 My Commission Expires:
6.TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . $ 487,800.00 /
(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-
304,860.00 prising the above application, the Architect certifies to owner that to the best of the Architect's
(Line 6 from prior Certificate). . . . . . . . . . . . . . . . . . . . .$ knowledge, information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . .$ 182,940.00 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) $ 0.00 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 39,300.00 -15,000.00 By. Date:
Total approved this Month 0.00 0.00 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 3000.00 -15,000.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 24,300.00
AIA Type Document
Application and Certification for Payment Page 2 of 2
DISTRIBUTION
CARMEL REFLECTING POND APPLICATION NO: 2
TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT:
30 W. MAIN ST. TO:
SUITE 220 PERIOD TO:7/15/2015 _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 386,300.00 251,095.00 135,205.00 0.00 386,300.00 100.00 0.00 0.00
LEVEING
2 UNDERDRAIN, 126,800.00 63,400.00 63,400.00 0.00 126,800.00 100.00 0.00 0.00
WATERPROOFING,TIE-IN
3 DEDUCT FOR MT.AIRY -49,600.00 -32,240.00 -17,360.00 0.00 -49,600.00 100.00 0.00 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 16,150.00 0.00 0.00 16,150.00 100.00 0.00 0.00
RATES
6 REBUILT EAST EFFECTS 23,150.00 16,205.00 6,945.00 0.00 23,150.00 100.00 0.00 0.00
PLATFORM
7 SOUTH UNDERDRAIN -15,000.00 -9,750.00 -5,250.00 0.00 -15,000.00 100.00 0.00 0.00
DEDUCT/TIE-IN
REPORT TOTALS $487,800.00 $304,860.00 $182,940.00 $0.00 $487,800.00 100.00 $0.00 $0.00
AFFIDAVIT AND WAIVER OF LIEN
[X] Final [ ] Partial [X] Payment to Follow
State of Indiana
County of Marion
T.M. Fansler , being duly sworn states that lie 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: $( 0.00)
[ ] receipt of which is hereby acknowledged; or
[ ] 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 from the owner is the sum of($182,940.00)
One Hundred Eighty Two Thousand Nine Hundred Forty 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 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.
_/kc_4�_
SMOCK FANSLER CORP. ByTitle CEO
T.M. Fansler pummmuuumuirn
\\\ NOTAR Y
WITNESS MY HAND AND NOTARIAL SEAL, this 15`h day of July ,2015.
Melissa J. Bish p Notar Public = AL
moi, � •••... •. ��
My commission expires_November 30, 2016 Residing in Mor an County
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�n(.k Fan
Sler (or p4rAil-N) Purchase Order No.
Anhe5AA V. Terms
In�iclnclpO�1S T� 4 62�h1 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total �b Z •��
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.
ALLOWED 20
Smock IN SUM OF $
2910 V Anne s & S+.
146aplislAt 46241
ON ACCOUNT OF APPROPRIATION FOR
Cash Boz/ I�bo�n3
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
2 g S 8 6 00 or bill(s) is (are) true and correct and that
3312 2 the materials or services itemized thereon
for which charge is made were ordered and
received except
X20
Si at
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund