HomeMy WebLinkAboutSmock - $4,811.50 The National Bank of Indianapolis 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
Amount to be paid by Carmel Theater Development as per the Motor Court
Improvements installment purchase contract
Application 3(Smock) October 2011 $ 2,428.65
it
Total Authorized Disbursement $ 2,428.65
All terms used in these Disbursement Instructions without definition shall have the meanings ascribed
thereto in that certain Loan Agreement (Equipment and Improvements), dated February 23, 2010, by and
between The National Bank of Indianapolis and Carmel Theater Development Company, LLC.
Dated: 1//Z eAl CITY OF CARMEL REDEVELOPMENT
COMMISSION
By: 1110111" .'
Les S. Olds
Printed:
Executive Director
Title:
Motorcourt Improvements - Planters
(Smock)
August 2011
Application 1
Paid by Carmel Theater Development $ 32,214.60
September 2011
Application 2
Paid by Carmel Theater Development $ 12,143.25
October 2011
Application 3
Amount to be paid by Carmel Theater Development $ 2,428.65
AIA Type Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):CARMEL REDEVELOPEMENT COMM. PROJECT:PRECAST URNS/CARMEL CITY CTR APPLICATION NO: 3 DISTRIBUTION
ONE CIVIC SQUARE 30 W.MAIN ST. PERIOD 70:10/31/2011 TO:
CARMEL,IN 46032 CARMEL,IN 46032 _OWNER
_ARCHITECT
_CONTRACTOR
FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S
2910 W.Minnesota Street PROJECT NO:
Indianapolis, IN 46241
CONTRACT FOR: CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and
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,runrr,r�r4
1.ORIGINAL CONTRACT SUM $ 51,985.00 °' v
0.00 CONTRACTOR: Smock Fansler Corporation -1'.<9<-�'•�
2.Net Change by Change Orders $ `` �
2910 W.Minnesota Street Indianapolis, IN 46241
3.CONTRACT SUM TO DATE(Line 1 +2) $ 51,985.00 -A-: `� .
4.TOTAL COMPLETED AND STORED TO DATE $ 51,985.00 By: / i"
Date: i ..i,7.1 1, -�I__., _-
T.M.FANSLER / CEO % u \.
5.RETAINAGE: State of:IN -; '•?jF••. ...•••�Q ''`
a. 10.00%of Completed Work $ 5,198.50 �';;,. OF IND\P\\\��;;'
County of: MORGAN "y'i,f��!!I1iiiin,,r�,V
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this /'':::-i- Day of (,'/. /./':�ticj` 20 /t/
Notary Public: 1//''',), -/ /1 4 /)
Total retainage(Line 5a+5b) $ 5,198.50 /. . , i"iy/, r_is G• 1!
My Commission Expires: / ),/:-:',/1/;),W7.
6.TOTAL EARNED LESS RETAINAGE $ 46,786.50
(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 prior Certificate) $ 44,357.85 prising the above application, the Architect certifies to owner that to the best of the Architect's
knowledge,information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE $ 2,428.65 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED.
(Line 3 less Line 6) $ 5,198.50 AMOUNT CERTIFIED $ ).y4./
(Attach explanation if amount c-.'led differs from the amount applied.Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on t • nu. on Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT:
previous months by Owner 0.00 0.00 By: V
Y� Date: /0/dI h
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 p nt 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 /
CM 10 1.301
/�r
1
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):CARMEL REDEVELOPEMENT COMM. PROJECT:PRECAST URNS/CARMEL CITY CTR APPLICATION NO:3 DISTRIBUTION
ONE CIVIC SQUARE 30 W.MAIN ST. TO:
CARMEL,IN 46032 CARMEL,IN 46032 PERIOD TO:10/31/2011 _OWNER
_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 MOLD CONSTRUCTION 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00 0.00 2,500.00
2 PRODUCT PRODUCTION 26,985.00 24,286.50 2,698.50 0.00 26,985.00 100.00 0.00 2,698.50
REPORT TOTALS $51,985.00 $49,286.50 $2,698.50 $0.00 $51,985.00 100.00 $0.00 $5,198.50
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 CEO of SMOCK FANSLER CORP.
having contracted with: Carmel Redevelopment Commission to furnish certain labor, materials,
and/or services as follows: Misc. Construction for a project known as: SFC#11-076 Precast Urns (a)
Carmel City Ctr. 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: ($2,428.65)
Two Thousand Four Hundred Twenty Eight Dollars and 65/100
[ ] receipt of which is hereby acknowledged; or
[X] the payment of which has been promised asthe 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 uponreceipt 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 J/21,, Title CEO
T.M. Fansler
WITNESS MY HAND AND NOTARIAL SEAL,this 19`h day of October,2011.
Melissa J. Bishop Notafy Public
My commission expires November 30,2016 Residing in Morgan County