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Home My WebLink About169782 03/17/2009 CITY OF CARMEL, INDIANA VENDORS 00350511 Page 1 of 1 ONE CIVIC SQUARE SMOCK FANSLER CORP CHECK AMOUNT: $10,702.80 CARMEL, INDIANA 46032 2910 WMINNESOTA ST INDIANAPOLIS IN 45241 CHECK NUMBER: 169782 CHECK DATE: 3/17/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460848 2512 10,702.80 4TH GATEWAY /RANGELINE a REQUEST FOR PAYMENT From: Smock Fansler Corporation To: CITY OF CARMEL Invoice: 2512 2910 W. Minnesota Street LES OLDS, DIRECTOR OF CRC Draw: APP00002 Indianapolis, IN 46241 -4541 ONE CIVIC SQUARE Invoice date: 2/24/2009 CARMEL, IN 46032 Period- ending date: 2/28/2009 Contract For: Request for payment: Original contract amount $71,675.00 Approved changes $25,450.00 Project: 08098 Revised contract amount $97,125.00 CARMEL. PARCEL 48. GATEWAY ARCH Contract completed to date $20,736.25 Contract date: Add -ons to date $0.00 Taxes to date $0.00 Less retainage $2,073.63 Architect: Total completed less retainage $18,662.62 Scope: Less previous requests $7,959,82 Current request for payment $10,702.80 Current billing $11,892.00 Current additional charges $0.00 Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Less current retainage $1,189.20 Changes approved in previous 25,450.00 Current, amount due $10,702.80 Total a pproved this Month Remaining contract to bill $78,462.38 TOTALS 25,450.00 NET CHANGES by Change Order 25,450.00 hereby certify that the work performed and the materials supplied to date, as shown on the above represent the actual value of the accomplishment under the terms of the Contract paid all am tously billed and paid by the own�the undersigned and the CITY OF CARMEL relating to the above referenced project. t also certify that the contractor has CONTRACTOR: Smock ansler Corporation State Of INDIANA County Of MORGAN By: Subscribed and sworn to before me this X97 Y L day of P 16h ii 1 2 S EAL Date: �y 7 7 Notary Public 1 4 W&L f My commission expires: �0'0Z.,50 REQUEST FOR PAYMENT DETAIL Proj ect: 08098 CA RMEL PA RCEL 48, GATEWAY AR Invoice: 2512 Draw: APP00002 Period En ding Date: 2!28!2009 Oetaii Page 2 of 2 Pages Item ID Description Total Previously Work Presently Completed Balance Retainage Contract Completed Completed Stored And Stored Comp To Balance Amount Work This Materials To Date Finish Period 001 MOBILIZATION 5,000.00 2,500.00 2,500.00 50.00 2,500.00 250.00 002 CONCRETE 57,675.00 6,344.25 8,074.50 14,418.75 25.00 43,256.25 1,441.88 003 PAINT 4,000.00 4,000.00 004 LANDSCAPE PAVERS 5,000.00 5,000.00 005 CHANGE ORDER 1 25,450.00 3,817.50 3,817.50 15.00 21,632.50 381.75 Totals 97,125.00 8,844.25 14;892.00 20,736.25 21.35 76,388.75 2,073.63 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 C.E.O. of SMOCK FANSLER CORPORATION having contracted with: City of Carmel to furnish certain labor, materials, and /or services as follows_ Misc. Construction for a project known as: SFC #08 -098 Carmel Parcel 48, Gateway Arch 4 located at Carmel, Indiana and does hereby state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the owner the sum of ($10,702.80) Ten Thousand Seven Hundred Two Dollars and 80 /100 receipt of which is hereby acknowledged; or [X] the payment of which has been promised as the sole considera4on 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 ��C� G� itle C.E.O. T.M. Fansler WITNESS MY HAND AND NOTARIAL SEAL, this 24" day of February 2009. Ry r r p rrr &Z 444 Melissa J. Bis op Not Publice' SEA My commission expires 11/30/2016 Residing in Morgan County F,�p1P\\\\\\\�` 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 &I-"/z Purchase Order No. Terms I�fu�,u�a/ �fS�/ Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) t F�r Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer V VOUCHER NO. WARRANT NO. ALLOWED 20 co IN SUM OF r ON ACCOUNT OF APPROPRIATION FOR T /�o 9 02-� y�'�a� y9 Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), 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 S'gnatur Title Cost distribution ledger classification if claim paid motor vehicle highway fund