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318989 11/22/17 CITY OF CARMEL, INDIANA VENDOR: 00350511 ONE CIVIC SQUARE SMOCK FANSLER CORP CHECK AMOUNT: $***122,714.25* q CARMEL, INDIANA 46032 2910 w MINNESOTA ST CHECK NUMBER: 318989 ruN c� INDIANAPOLIS IN 46241 CHECK DATE: 11/22/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460841 100530 1 122,714.25 DEMOLITION OF 15 1ST VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00350511 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER SMOCK FANSLER CORP IN SUM OF$ CITY OF CARMEL 2910 W MINNESOTA ST 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. INDIANAPOLIS, IN 46241 Payee $122,714.25 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Redevelopment Commission Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 100530 1 44-608.41 $122,714.25 1 hereby certify that the attached invoice(s),or 10/31/17 1 demolition of buildings and parking lot $122,714.25 902 902 902 902 construction T—F 1110 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Wednesday, November 22,2017 C - Meyer,Corrie I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer AIA Type Document Application and Certification for Payment Page 1 of 2 TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT:BLDG&LOT DEMO FOR CRC APPLICATION NO: 1 DISTRIBUTION 30 W.MAIN ST. TO: SUITE 220 PERIOD.70:10/31/2017 _OWNER CARMEL, IN 46032 _ARCHITECT —CONTRACTOR FROM(CONTRACTOR): Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S 2910 W.Minnesota Street PROJECT NO: Indianapolis, IN 46241 CONTRACT FOR: CONTRACT DATE: The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and CONTRACTOR'S APPLICATION FOR PAYMENT belief the work covered by this application for Payment has been completed in accordance with the Application is made for Payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that current payment shown herein is now due. 1.ORIGINAL CONTRACT SUM .. . .... . ... .. . .. . . ..$ 135,675.00 2.Net Change b Change Orders $ 0.00 CONTRACTOR: Smock Fansler Corporation iC Y 9 2910W.Minnesota Street Indianapolis,IN 46241 ;. 3.CONTRACT SUM TO DATE (Line 1 +2).. . . ..... . . $ 135,675.00 4.TOTAL COMPLETED AND STORED TO DATE ... . .. $ 122,714.25 / s' i � tir By: f Date: =h 1 2 /it �t� i) T.M.FANSLER / CEO S.RETAINAGE: o0.00 State of:IN /o '� ^7 .• `\� \\\Q� a. 0.00 of Completed Work 0 $ .00 �F ti\ County of: MORGAN 'U�"an 7n➢�ID'��4�v��00� b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this ? 7%, Day of 20 Total retainage Line 5a+5b 0.00 Notary Public: My Commission Expires: M3 Qa l 6.TOTAL EARNED LESS RETAINAGE. ..... .... . ... $ 122,714.25 (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- Line 6 from 0.00 prising the above application, the Architect certifies to owner that to the best of the Architect's ( prior Certificate)''' ' ' '''' ' '''' ' ''' ' ' '$ knowledge, information and belief the Work has progressed as indicated,the quality of the work 8.CURRENT PAYMENT DUE .. . .. . ... . ... . . ... . ..$ 122,714.25 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) $ 12,960.75 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 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 0.00 0.00 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 0.00 �r AIA Type Document Application and Certification for Payment Page 2 of 2 TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT: BLDG&LOT DEMO FOR CRC APPLICATION NO: 1 DISTRIBUTION 30 W.MAIN ST. TO: SUITE 220 PERIOD TO:10/31/2017 _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 BLDG&UTILITY DEMOLITION 39,650.00 0.00 39,650.00 0.00 39,650.00 100.00 0.00 0.00 2 SITE DEMO,HARDSCAPE, 67,165.00 0.00 57,090.25 0.00 57,090.25 85.00 10,074.75 0.00 LANDSCAPE 3 PARKING LOT PAVING& 28,860.00 0.00 25,974.00 0.00 25,974.00 90.00 2,886.00 0.00 SIGNAGE REPORT TOTALS $135,675.00 $0.00 $122,714.25 $0.00 $122,714.25 90.45 $12,960.75 $0.00 AFFIDAVIT AND WAIVER OF LIEN [ ] Final [X] Partial [ ] 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: Mise. Construction for a project known as: SFC#17-066 Building & Lot Demo located at Carmel,IN and does hereby state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due.from the owner the sum of ($122,714.25) One Hundred lvventy Two Thousand Seven Hundred Fourteen Dollars and-25/100 [ ] 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 from the owner is 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 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 d` Title CEO T.M.Fansler WITNESS MY HAND AND NOTARIAL SEAL this 201h day of October,2017. "`` .�ti'• -.`�' "`'% °\t=J Melissa J. Laue Notary Public ��' r-`� My commission expires_October 23, 2024 Residing in Morgan County o`�