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Home My WebLink AboutLaFever Electric - Motor Court Stairs - $693.50 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 _ LaFever Electric,Inc.Application 1 $693.50 Total Authorized Disbursement $693.50 All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (PAC Millwork), dated,as of January 28,2010,by and between Lender and Village Financial,LLC. Dated: //ZIA, CITY OF CARMEL REDEVELOPMENT COMMISSION By ii Printed Le.S S. 0((1) Title Exec_td- DirecTOr APPLICATION AND CERTIFICATE FOR PAYMENT TO OWNER:Village Financial,LLC PROJECT:P112 Motor Court Stairs APPLICATION NO 1 770 Third Avenue,SW 720 Rangeline Road PERIOD TO: 11/30/2012 Carmel,Indiana 46032 Carmel,IN 46032 PROJECT NO: 1865 FROM CONTRACTOR:LaFever Electric,Inc. VIA ENGINEER:Signature Construction,LLC JOB NO: ' 131 N.Rangeline Road 720 Third Avenue,SW CONTRACT DATE 9/13/2012 Carmel,IN 46032 Carmel,Indiana 46032 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance 1 ORIGINAL CONTRACT SUM $ 7,300.00 with the Contract Documents,that all amounts have been paid by the Contractor for Work for 2 NET CHANGE BY CHANGE ORDERS $ - which previous Certificates for payment were issued and payments received from the Owner, 3 CONTRACT SUM TO DATE(Line 1±2) $ 7,300.00 and that current payment shown herein is now due. 4 TOTAL COMPLETED AND STORED TO DATE $ 730.00 (Column G on G703) CONTRACTOR: LaFever Electric,Inc. 5 RETAINAGE: 5 %of Completed Work $ - Li ��/(Columns D+E) By: Date:November 27,2012 5 %of Stored Material $ 36.50 Chris A.LaFevor (Column F) Total Retainage(Line 5a+5b or Total in Column I) $ 36.50 State of:Indiana 6 TOTAL EARNED LESS RETAINAGE $ 693.50 County of Hamilton ""., , '?' Pk,' (Litre 4 less Line 5 Total) Subscribed and sworn to befdi'el�,�`' '' ,,, r, 7 LESS PREVIOUS CERTIFICATES FOR PAYMENTS me ' +7 - •a NWem',Tief20i' �. ')"a (Line 6 from prior Certificate) $ - 1-------- _ f°', r - No-.ry Publio•--eti to th'111a€l.Jf. �`-r` Li . ; . •. 8 CURRENT PAYMENT DUE(Line 6 less Line 7) '$ 693.50 I My • Ission expires: 9 BALANCE TO FINISH,INCLUDING RETAINAGE (Line 3 less Line 6) $ 6,606.50 0'✓ ,,, `- s h' •. ,l''~x CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner - _ Total approved this month TOTALS - - ))"1.••• NET CHANGES by Change Order - "'*�'� JOB NAME Motor Court Stairs APPLICATION DATE 11/27/2012 PAGE NUMBER 1 APPLICATION NUMBER 1 PERIOD TO 11/30/2012 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G+C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 1 Electric and light fixtures 7,300.00 - 730.00 730.00 10 6,570.00 36.50 M -- - - L - - - - - - M - - - L - - - - M - - L -- - M - - L _- M _- - -- - L - - - - M - - L M - - - -L _ _ -- -M - - - -L _ - M L M - L -- - - - M - - - - L 7,300.00 - 730.00 - 730.00 6,570.00 36.50 AFFIDAVIT AND WAIVER OF LIEN Final [ j Partial Q Payment to Follow Stale or Indiana,County of Hamilton ,SS: Chris A. LaFever being duly sworn states that helsho is the Vice-President or (Herne tit acel) %Tale) LaFever Electric,Inc. having contracted with Signature Construction, LLC to fun nish.cetlah% Isob uld=to,such (Contractor) materials and/or labor as follows electrical work tuescripaom for the project known as P112 Motor Court Stairs located at 720 Rangeline Road, Carmel, Indiana 46032 and owned by Village Financial, LLC tOvwnelh and dues Ineteby ruuther state on behalf of the aforementioned subcontractor/supplier. (PARTIAL WAIVER)that there Is due from the contractor the sum of Six Hundred Ninety-three Dollars and Fifty Cents Dollars ($693.50 [ ]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 contractor Is the sum of ( ) [ ] 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 or material or both,furnished by the undersigned thereto,subject to limitations or conditions expressed herein,If any and further certifies that no other pasty has any claim or right to a lien on account of any work performed or material ss led to ti = undersigned for said project, and within the scope of this affidavit and waiver. 10110"-- La Fever Electric, Inc. By �. Title Vide-President (Farm) _ W- WITNESS MY HAND AND NOTARIAL SEAL,lids 27th :?' :c f 1 �;°=';, N ember .20 12 My Commission Expires: April 11,2018 Pan f ' ` yOPI =_ S. Ma el Residing in Madison County Attachment A TRANSFER OF TITLE LaFe_ver-Ele f c jnc:�,F ("Contractor") transfers to Village Financial, LLC any and all right, title and/or interest that Contractor has in any labor and/or materials described in (i) that Affidavit of Waiver of Lien executed by the Contractor on November , 27 , 2012 , and (ii) in the "Amount of this Request" section of that Affidavit executed by the Contractor on November , 27 , 20 12 . Upon Receipt of Payment $693.50 Six hundred ninety three dollars and fifty cents. "CONTRACT," c, 8y: ` /(� U 1:4 Printed: Chris A. LaFever Title: Vice President