HomeMy WebLinkAboutLaFever 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
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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