HomeMy WebLinkAboutCoreslab Structures - $52,960 Exhibit D
Disbursement Instructions
Regions Bank hereby is instructed to make a disbursement of Loan Proceeds from the
Borrower Loan.Account to (or for the account of) Borrower in: (a) the amount of the "Total
Authorized Disbursement: line in the "Amount of Authorized Disbursement"column below;
and (b) accordance with the terms and conditions of the Agreement, the other Loan
Documents,and the Disbursement instructions.
Purpose of Authorized Disbursement Amount of Authorized Disbursement
Coreslab Structures Appl.#1 $ 6,003.00
Coreslab Structures Appl.#2 $41,661.00 _
Coreslab Structures Appl.#3 (Retainage) $ 5.296.00
Total Authorized Disbursement $52,960.00
All terms used in these Disbursement Instructions without definition shall have the meanings
ascribed thereto in that certain Loan Agreement (PAC Stage Equipment), dated,as of
January 28,2010,by and between Lender and Village Financial,LLC.
Dated: 2/2/0 /3 CITY OF CARMEL REDEVELOPMENT
COMMISSION
By
Printed I-if S. al-Al
Title
raw. O/n�
/ 5
7
APPLICATION AND CERTIFICATION FOR PAYMENT AlA Document G702
To Owner or General Contractor: Project: Application No.: I Revised Copies to:
Signature Construction Carmel City Center Motor Application Date: 10/17/2012 1 Owner
720 3rd Avenue SW Court.Stair Period To: 10/31/2012 0 Architect-originals
Carmel,IN 46032 Regions PAC RECEIVED JAN ".�j `o: 12.022 0 General Contractor
From Contractor: Architect: C.00n'f'aM Date: 01/00/1900 0 SubContractor
Coreslah Strictures(Indianapolis)inc. Contract For: Precast Concrete •
1030 S.Kitley Ave.
Indianapolis.IN 46203
CONTRACTOR'S APPLICATION FOR PAYMENT Contractor's Certificate for Payment
Application is made for Payment,as shown below,in connection with the Contract. Continuation The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief
Sheet,AlA Document G703 is attached. the Work covered by this Application for Payment has been completed in accordance with the Contract
Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for
Payment were issued and payments received from the Owner,and that current payment shown herein is
now due.
1. Original Contract Sum $ 52,960.00
2_ Net change by Change Orders $0.00 CONTRACTOR: Coreslab Structures(Indianapolis)Inc.
3. Contract Sum to Date(Line I±2) $ 52.960.00
4. Total Completed&Stored $ 6,670.00 � (/V�/ J
(Column 0 on Detail Sheet) By: ∎`— . Date: 10/17/2012
5. Rctainage
a. 10% of Completed Work $ 667.00 State of Indiana County of tynRt✓,c,tJ
(Column D+E on Continuation) Subscribed and swotn to before me on: 10/17/2012
h. 10% of Stored Materials $ J 7 401r:`c r r:S�cLD CPA,
Notary Public: y.2zat_ i�.dLea�t .F ,inTta<,RY 1'U13LlC
(Column F on Continuation) m
My Commission expires: 'iil jib �� ��' STATE C AL „t_
Total Retainage Lines 5a+5b $ 667.00 Ely Comm.t-.:- e 7 20'
6. Total Earned Less Retainage(Line 4 Less Line 5's Total) $ 6,003.00 Certificate for Payment
7. Less Previous Certificates for Payment In accordance with the Contract Documents,based on on-site observations and the data
(Line 6 from prior Payment Request) $ - comprising the application,the Architect certifies to the Owner that to the best of the Architect's
8. Current Payment Due S 6,003.00 knowledge,information and belief the Work has progressed as indicated,the quality of the
8a_Current Completed Including Rctainage $ 6,670.00 Work is in accordance with the Contract Documents,and the Contractor is entitled to payment
8b. Refainage Being Feld This Period $ 667.00 of the Amount Certified. ,
Amount Certified $ CP �/
9. Balance to Finish Including Retainage Being Held $ 46,957.00 (Attach explanation if amount certified deers from the amour applied for.Initial all figures on this
(Line 3 less Line 6) Application and on the Continuation.Sheet that are changed to conform to the amount certified.)
Change Order Summary Additions Deductions
Total approved in previous months $0.00 $0.00
ARCHITECT: r^..c.—Tom- \,+
�'a, `�� f i
Total approved this month $0.00 $0.00 By: :I '• E ` 1 ` '�
Totals $0.00 $0.00 This Certificate is not negotiable. The Amount Certified is payahle�only.t6 the Contractor
named herehi.lss_uanee, yment and acceptance of payment are without Prejudice to any rights
Net Changes by Change Order of the Owner or Contractor under this Contract. y'
AIA DOCUMENT G703
Project:
Cannel City Center Motor pplicationn Date: 1 Revised
Contract For: Application Date: 10!17!2012
Period To: 10/3112012
Precast Concrete Project Number: 12.022
Contract Date:
A B C D E ( F G H i
Previous Work This Month
Item Description Schedule Of Values Completed& Total Completed& Percent
p Work Completed Materials Stored Materials Stored Complete Balance to Finish Retainage
Materials Stored
Orignal Contract
En9.ineerin9,__........__.._. 6,670.00 6,670.00 6,670.00 100.00% 667.00
Production 16,020.00 0.00% 16,020.00
Delivery... 3,075.00 0.00% 3,075.00
Erection/Field Services 15,160.00 0.00% 15,160.00
Prec2st Stair Units 12,035.00 0.00% 12,035.00
Subtotal 52,960.00 6,670.00 6,670.00 12,59% 46,290.00 667.00
Change Orders
1 _...._...._.._....._..........._..__.._..__..__---..__._._............_... 0.00%
•
2 _._................•............ — --- 0.00%
0.00%
)Subtotal..
GRAND TOTALS 52,960.00 6,670.00 6,670.00 12.59% 46,290.00 667.00
0
PARTIAL
WAIVER OF LIEN
(Payment to Follow)
State of Indiana Marion County ss:
WHEREAS The undersigned Coreslab Structures(Indianapolis)Inc has been heretofore
(Name of Declarer)
employed by Signature Construction To furnish certain material
(Contractor)
and labor to:wit: Precast Concrete Pieces
(Work performed)
for the project: Carmel city Center Motor Court Stair
and located on Carmel, Indiana
(Exact legal description and street address,if any,of the land on which
the improvement Is situated or to which it may be removed)
• NOW, THEREFORE, KNOW YE, that the undersigned, upon the receipt of Payment application # I in
the amount of...
Six Thousand Three dollars and no/cents Dollars ($6,003.00)
It hereby and now waives and releases unto the said owner of said premises,any and all lien,right of lien or claim of whatsoever kind
or character on the above described building and real estate,TO AND FOR SAID AMOUNT,on account of any and all labor,material
or both,furnished for or incorporated Into said building by the undersigned,up to this date and further,he represents that no
other person or party has any right to a lien on account of any work performed or material fumished by said company. THIS PARTIAL
WAIVER OF LIEN has been given upon the promise to pay the amount as Indicated on the attached statement or payment application.
Coreslab Structures(Indianapolis)Inc. By: VP/GM
(Name of Claimant firm) (Authorized Representative) (Title)
STATE OF Indiana
ss:
COUNTY OF Marion
Before me,a Notary Public in and for said County and State,personally appeared (11FY(T Opcu_p,t
who acknowledged the execution of the foregoing PARTIAL Waiver of Lien, and who, having been duly sworn, stated that the representations therein
ontained are true.
Witness my hand and Notarial Seal this 17'" day of October 2012
Signature ?fit + }t_ 1141;9077to
Volere S.Hasseld
Printed: +:' "OLERE S HA SSELD CPA.
9/17117 �)
f NOTARY PUBLIC
41t?LiC tt
My commission expires: P(J
Hamilton r,�E c,f
ny C;c: :n. ,..c:^: 1�'c n !,!.261? I
County of Residence: , ,,_
1 :3 7r
APPLICATION AND CERTIFICATION FOR PAYMENT AIA Document G702
To Owner or General Contractor: Project: Application No.: 2 Co•ics to:
Signature Constntction Carmel City Center Motor Application Date: 11/28/2012 in Owner
720 3rd Avenue SW Court Stair Period To: 12/31/2012 No Architect-originals
Carmel,IN 46032 Regions PAC RECEIVED Project No.: 12.022 0 General Contractor
VEp
From Contractor: Architect: JAN 2 T-.2fitact Date: 01/00/1900 0 SubContractor
Coreslab Stnictures(Indianapolis)Inc. Contract For: Precast Concrete _
1030 S.Kitley Ave. _
Indianapolis,iN 46203
CONTRACTOR'S APPLICATION FOR PAYMENT Contractor's Certificate for Payment
Application is made for Payment,as shown below,in connection with the Contract. Continuation The undersigned Contractor certifies that to the hest of the Contractor's knowledge,information and belief
Sheet,AIA Document G703 is attached. the Work covered by this Application for Payment has been completed in accordance with the Contract
Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for
Payment were issued and payments received from the Owner,and that current payment shown herein is
now due.
1. Original Contract Sum $ 52,960.00
2. Net change by Change Orders $0.00 CONTRACTOR: Coreslab Structures(Indianapolis)Inc.
3. Contract Sum to Date(Line 1±2) $ 52,960.00
4. Total Completed n Stood $ 52.960.00 A,<;��� P�
(Column G on Detail Sheet) By: Date: 11/28/2012
5. Retainage
a. 10% of Completed Work $ 5,296.00 State of Indiana County of f11RCtot3
(Column 1)+Eon Continuation) Subscribed and sworn to before me on: 11/2 /2012
: im.+ �f OL—r-6S.V'�ASFA..'•.t_i:li{'i7. I pr b. 10% of Stored Materials $ Notary.Public: �'/2,;, f -�'.>? .t 'n,=,`f F;Tr,I.,7 l
(Column F on Continuation) 14• SEy'41_ f
My Commission expires: 61//-71/1 ��{" 7�' STATE:O
Total Retainage Lines 5a+5b $ 5,296.00 ) My 20,7 1
c
6. Total Earned Less Retainage(Line 4 Less Line 5's Total) 5 47,664.00 Certificate for Payment
7. Less Previous Certificates for Payment In accordance with the Contract Documents,based on on-site observations and the data
(Line,6 from prior Payment Request) $ 6,003.00 comprising the application,the Architect certifies to the Owner that to the hest of the Architect's
8. Current Payment Due $ 41,661.00 knowledge,information and belief the Work has progressed as indicated,the quality of the
8a.Current Completed including Retainage $ 46,290.00 Work is in accordance with the Contract Documents,and the Contractor is entitled to payment
8b.Retainage Being Held This Period $ 4,629.00 of the Amount Certified. 3 t �_
Amount Certified $ 1'1-�t O
9. Balance to Finish Including Retainage Being Held $ 5,2
96.00 (Attach explanation if amount certified di[jcry from lie amount applied fnr.Initial al(.fgures on this
(Line 3 less Line 6) Application and in the Continuation Sheet that are changed to cot jinn to the amount certified.)
Change Order Summary Additions Deductions
•
Total approved in previous months $0.00 $0.00 \
ARCHITECT: 41 ��
i.1
Total approved this month $0.00 $0.00 By: 1 tl`,, Date: r�•
} I�
Totals $0.00 $0.00 This C:ertifictlte is not negotiable. The Amount Certified is payable!nly tohhe Contractor
named herein.llt rta�ce. yrnent and acceptance of payment are with ut prttjudice to any rights
Net Changes by Change Order of the Owner or Contractor under this Contract.
AIA DOCUMENT G703
Project: Application No.: 2
Carmel City Center Motor Application Date: 11/28/2012
Contract For: Period To: 12/31/2012
Precast Concrete Project Number: 12.022
Contract Date:
A B C D E I F G H I
-
Previous Work This Month -
Item Description Schedule Of Values Completed& Total Completed& Percent
Materials Stored
Work Completed Materials Stored Materials Stored Complete Balance to Finish Retainago
Orignai Contract
-
Engineering......................................_... _............._............6,670.00 6,670.00 6,670 00 100.00%
667.00
Production 16,020.00 16,020.00 16,020.00 100.00%
1,602.00•
Delivery 3,075.00 3,075.00 3,075 00 100.00%
Erection/Field Services 15,160.00 15,160.00 .................._.......__._._......._.........._.._...._._._... __-15,160.00 100.00% 1,516.00
Precast Stair Units 12,035.00...... 12,035.00 ..............._...,...._._....................................._.__._......_.........._12,035.00 100.00%.........._............_..__..............................._.......... 1,203.50
Subtotal 52,960.00 - 6,670.00 46,290.00 52,960.00 100.00% 5,296.06
Change Orders
1 0.00%
2 - - 0
3 -.. ........_............... ._.._.-0.00%............._._..__..._
I Subtotal
... .. I A
GRAND TOTALS 52,960.00 6,670.00 46,290.00 52,960.00 100.00% 0.00 5,296.00
0
PARTIAL
WAIVER OF LIEN
(Payment to Follow)
State of Indiana Marion County ss:
WHEREAS The undersigned Coreslab Structures(Indianapolis) Inc has been heretofore
(Name of Declarer)
employed by Signature Construction To furnish certain material
(Contractor)
and labor to:wit: Precast Concrete Pieces
(Work performed)
for the project: Carmel city Center Motor Court Stair
and located on Carmel, Indiana
(Exact legal description and street address,if any,of the land on which
the improvement is situated or to which it may be removed)
NOW, THEREFORE, KNOW YE, that the undersigned, upon the receipt of Payment application # 2 in
the amount of..,
Forty-one Thousand Six Hundred Sixty-one dollars and no/cents Dollars ($41,661.00)
It hereby and now waives and releases unto the said owner of said premises,any and all lien,right of lien or claim of whatsoever kind
or character on the above described building and real estate,TO AND FOR SAID AMOUNT,on account of any and all labor,material
or both,furnished for or incorporated into said building by the undersigned,up to this date and further,he represents that no
other person or party has any right to a lien on account of any work performed or material furnished by said company. THIS PARTIAL
WAIVER OF LIEN has been given upon the promise to pay the amount as indicated on the attached statement or payment application.
Coreslab Structures(Indianapolis)Inc. By: fin VP/GM
(Name of Claimant firm) (Authorized Representative) (Title)
STATE OF Indiana
ss:
COUNTY OF Marion
Before me,a Notary Public in and for said County and State,personally appeared Cn R ■ 6 ik i,h r tJ
who acknowledged the execution of the foregoing PARTIAL Waiver of Lien, and who, having been duly sworn, stated that the representations therein
ontained are true.
Witness my hand and Notarial Seal this 28'" day of November 2012
Signature Q/�I V #409 0776
Volere S.Hasseld _ M t f) ,p
Printed: {
9/17/17
My commission expires: ;i>cAtir
Hamilton
My
County of Residence:
•
APPLICATION AND CERTIFICATION FOR PAYMENT AIA Document G702
To Owner or General Contractor: Project: Application No.: 3 Retainae Copies to: -
Signature Construction Carmel City Center Motor Application Date: Ti72872612 1 Owner
720 3rd Avenue SW Court Stair Period'1'o: 12/31/2012 0 Architect-originals
Carmel,IN 46032 Regions PAC Project No.: 12.022 0 General Contractor
From Contractor: Architect: Contract Date: 01/00/1900 0 SubContractor
Coreslab Structures(Indianapolis)Inc. Contract For: Precast Concrete
1030 S.Kitley Ave.
Indianapolis,IN 46203
CONTRACTOR'S APPLICATION FOR PAYMENT Contractor's Certificate for Payment
Application is made for Payment,as shown below,in connection with the Contract. Continuation The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief
Sheet,AIA Document G703 is attached. the Work covered by this Application for Payment has been completed in accordance with the Contract
Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for
Payment were issued and payments received from the Owner,and that current payment shown herein is
now due.
1. Original Contract Sum $ 52.960.00
2. Net change by Change Orders C $0,00 CONTRACTOR: Coreslab Structures(Indianapolis)Inc..
3. Contract Sum to Date(Line l :L 2)
RECEIVED VEQ JAN 5 2 �3 52,960.00
4. Total Completed&Stored 52,960.00 /f'
(Column G on Detail Sheet) By: -c.' /`-• Date: 11/28/2012
5. Retainage
State of Indiana County of P-\ -tb't�
Subscribed and sworn to before ne on: 1/28 0•Y2� ... ...-..--.. _
V.;L'"t :i 'H.A:SSnLD CPA
Notary Public: `f/ e,*i}cr -: i'vO T A�i'PUBLIC __ _
P `1111117 #GD9 7� s_,f
My Commission expires: ::TE:E:N=ior.,.lN,n>
Total from Retainage Column on Detail Sheet. $ - t,..,...._,,�'f,' ,, �'_ ,'� , -r 17,20t7•
6. Total Earned Less Retainagc(Line4 Less Line 5's Total) $ 52,960.00 Certificate for Payment —..._
7. Less Previous Certificates for Payment • In accordance with the Contract Documents,based on on-site observations and the data
(Line 6 from prior Payment Request) $ 47,664.00 comprising the application,the Architect certifies to the Owner that to the best of the Architect's
8. Current Payment Due $ 5,296.00 knowledge,information and belief the Work has progressed as indicated,the.quality of the
8a.Current Completed including Retainagc $ - Work is in accordance with the Contract Documents,and the Contractor is entitled to payment
8h. Retainagc Being Held This Period $ (5,296.00) of the Amount Certified. 572&1/ ,�----9
Amount Certified $ 1(
9. Balance to Finish Including Retainage Being Held $ - (Attach explanation if-amount certified di3O trsf-ov,the amount applied for.Initial all figures on this
(Line 3 less Line 6) Application and on the C'nntinuotion.Sheer that are changed to conform to the amount c er-t fed)
Change Order Summary Additions Deductions
Total approved in previous months $0.00 $0.00 ti,
ARCHITECT: � 'IA.
Total approved this month $0.00 $0.00 By: { �, V ''' Date:
Totals $0.00 $0.00 This Certil5 ate.is not neiable. The Amount Certified is payable/only to,/the Contractor
named hereirNssuance,p4yment and acceptance of payment are wi7hnt,t pi-bodice to any rights
Net Changes by Change Order
of the Owner or Contractor under this Contract. d I
AIA DOCUMENT G703
Project: Application No.: 3 Retainage
Carmel City Center Motor Application Date: 11/28/2012
Contract For: Period To: 12/31/2012
Precast Concrete Project Number: 12.022
Contract Date:
A B C D E 1 F G H I
Previous Work This Month Total Completed& Percent
Item Description Schedule Of Values Completed& Balance to Finish Retainage
Materials Stored Work Completed Materials Stored Materials Stored Complete
Orignal Contract
Engineering 6,670.00 6:670.00 6,670 00 100.00%
Production 16,020.00 16,029.00 16,020.00 100.00%
Delivery._._...........................-,_._.................._.-..-. 3,075.00 3,075.00 3,075.00 100.00%
Erection/Field Services 15,160.00 15,160.00 15,160.00 100.00%
Precast Stair Units 12,035.00 12,035.00 12,035.00 100.00%
Subtotal 52,960.00 52,960.00 52,960.00 100.00%
Change Orders
1..._._..__. 0.00%
2--- - -– —_ 0.00%
3 0.00%
Subtotal
GRAND TOTALS 52,960.00 52,960.00 1 1 52,960.00 100.00% 0.00 0.00
0