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Home My WebLink AboutSmock - $2,428.65 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 Motorcourt Improvements installment purchase contract Application 4(Smock) December 2011 $ 4,811.50 Total Authorized Disbursement $ 4,811.50 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: 'L//4i f2 CITY OF CARMEL REDEVELOPMENT / COMMISSION By: 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 Paid by Carmel Theater Development $ 2,428.65 December 2011 Application 4 Amount to be paid by Carmel Theater Development $ 4,811.50 ,'a 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: 4 DISTRIBUTION ONE CIVIC SQUARE 30 W. MAIN ST. TO: CARMEL, IN 46032 CARMEL, IN 46032 PERIOD TO: _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.ORIGINAL CONTRACT SUM $ 51,985.00 2. Net Change by Change Orders $ 0.00 CONTRACTOR: Smock Fansler Corporation �o"` \?�1IP'U�/!C"%i, 9 y g 2910 W. Minnesota Street Indianapolis, IN 46241 ,'SC'' ' 3.CONTRACT SUM TO DATE (Line 1 +2) $ 51,985.00 ---.-.-- .* •'• i •° '.-i 4.TOTAL COMPLETED AND STORED TO DATE $ 51,985.00 � ,// ��// pp By %� j. Date: 1:5(bi AkL T.M. FANSLER / CEO _�. 0 5. RETAINAGE: State of: IN a. 0.00%of Completed Work $ 0.00 County of: MORGAN %��oi STgT•••F�N`.\''' b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this 36 Day of . //j,k.P'f\W\2p°�. Total retainage(Line 5a+5b) $ 0.00 Notary Public: 1226e-i41`11/2-16 My Commission Expires : if/86410/ 6.TOTAL EARNED LESS RETAINAGE $ 51,985.00 (Line4lessLine5Total) 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) $ 46,786.50 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 $ 5,198.50 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 0.00 AMOUNT CERTIFIED $ 3190.5 ' (Attach explanation if amount certified differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on t e C.• .. b .eet that are changed to conform to the amount certified.) Total changes approved in ARCHITEC • previous months by Owner 0.00 0.00 By: 111113' Date: rj Total approved this Month 0.00 0.00 This Certifica - is not n-gotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. I --- e, Payment and acceptance of payment 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 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: 4 DISTRIBUTION ONE CIVIC SQUARE 30 W. MAIN ST. TO CARMEL, IN 46032 CARMEL, IN 46032 PERIOD TO:12/30/2011 _OWNER _ARCHITECT _CONTRACTOR FROM (CONTRACTOR): Smock Fansler Corporation VIA(ARCHITECT): ARCHITECTS 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 0.00 2 PRODUCT PRODUCTION 26,985.00 26,985.00 0.00 0.00 26,985.00 100.00 0.00 0.00 REPORT TOTALS $51,985.00 $51,985.00 $0.00 $0.00 $51,985.00 100.00 $0.00 $0.00 AFFIDAVIT AND WAIVER OF LIEN [X] Final [ ] 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 (ii 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: ($0.00) [ ] receipt of which is hereby acknowledged; or [ ] 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 owner is the sum of($5,198.50) Five Thousand One Hundred Ninety Eight Dollars and 50/100 [ ] receipt of which is hereby acknowledged; or [X] 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 �`/'�� itle CEO T.M. Fansler WITNESS MY HAND AND NOTARIAL SEAL, this 30"' day of December, 2011. o��"`��"�� iii _ V ',I Melissa J. Bishop Notary 'ublic =*.. SE, /� 1 My commission expires November 30, 2016 Residing in Morgan County ST ‘\\ Pl ie 0f\N 3\ \\\�