HomeMy WebLinkAboutSmock Fansler, Signature - $84,649.70 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
2 �l
Amount to be paid by Carmel Theater Development as per the Veteran's Way
Improvements installment purchase contract and the City Center
Drive/Rangeline Road Streetscape Improvements installment purchase contract '
Application 11 (Gibraltar) March 2011 $ 7,847.10 4
Application 15(Signature) February 2011 $ 817.55
Application 16(Signature) March 2011 $ 1,162.20 `1v
Application 9(Smock Fansler) March 2011 $ 52,728.75 �3
Application 15(Signature) March 2011 $ 7,360.79
Total Authorized Disbursement $ 69,916.39
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: 1C//1 CITY OF CARMEL REDEVELOPMENT
•
COMMISSION
By:
Les S. Olds
Printed:
Executive Director
Title:
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
Amount to be paid by Carmel Theater Development Company as per the
Decorative Fountains installment purchase contract
Application 2(Smock Fansler) March 2011. $ 13,957.87
Application 2(Signature) March 2011 $ 775.44
Total Authorized Disbursement $ 14,733.31
All terms used in these Disbursement Instructions without definition shall have the meanings ascribed
thereto in that certain Loan Agreement (Equipment and Improvements), dated July 22, 2010, by and
between Regions Bank and Carmel Theater Development Company, LLC.
Dated: 14/7 CITY OF CARMEL REDEVELOPMENT
COMMISSION
By: iZrK—_
Les S. Olds
Printed:
Executive Director
Title:
It is acknowledged and agreed by the parties that CRC has reserved the right to require, as a condition of
authorizing disbursement of Loan Proceeds from the Borrower Loan Account to (or for the account of)
Borrower: (a) completion of a satisfactory inspection by CRC of the portions of the Equipment and/or the
Improvements to which the disbursement relates; and (b) receipt of customary submittals.
Decorative Fountains
(Smock Fansler)
January 2011
Application 1
Paid by Carmel Theater Development $ 13,957.87
March 2011
Application 2
Amount to be paid by Carmel Theater Development $ 13,957.87
11
t
REQUEST FOR PAYMENT
From: Smock Fansler Corporation To: CARMEL THEATER DEVELOPMENT CORP Invoice: 3106
2910 W. Minnesota Street 11711 N PENNSYLVANIA ST. Draw: APP00002
Indianapolis, IN 46241-4541 CARMEL, IN 46032 Invoice date: 3/21/2011
Period ending date. 3/31/2011
Contract For:
Request for payment:
Original contract amount $62,035.00
Approved changes $0.00 Project: 11010
Revised contract amount $62,035.00 CITY CTR.CHANDELIER CT FOUNT
Contract completed to date $31,017.50 Contract date:
Add-ons to date $0.00
Taxes to date $0.00
Architect:
Less retainage $3,101.76
Total completed less retainage $27.915.74 Scope:
Less previous requests $13.957.87
Current request for payment $13,957.87
Current billing $15,508.75
Current additional charges $0.00
Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Less current retainage $1,550.88 Changes approved in previous
Current amount due $13,957.87 months by Owner
Total approved this Month
Remaining contract to bill $34,119.26 TOTALS
NET CHANGES by Change Order
I hereby certify that the work performed and the materials supplied to date,as shown on the above represent the actual value of the accomplishment under the terms of the
Contract(and all authorized changes thereof)between the undersigned and the CARMEL THEATER DEVELOPMENT CORP relating to the above referenced project. I also
certify that the contractor has paid all amounts previously billed and paid by the owner.
CONTRACTOR' Smock Fasler Corporation State Of INDIANA County Of MORGAN
•
Y
By � \_� rr Subscribed and sworn to before me this 0'1 day of %1:'r,";,S'(( ;x`�t( t f1 , ;'__.
Date: .1771 Al/ Notary Public ;'/(c. }
/< 1, .'/'^�I •
My commission expires: /-. t".
3/ /if ( / o:, J 05l)
' 1
aufra(32—,_. 3/3((x( Director of Redevelopment/,yy4 d ao-5-
P(Pt/
REQUEST FOR PAYMENT DETAIL
Project: 11010/CITY CTR.CHANDELIER CT FOUNT invoice: 3106 Draw:APP00002 Period Ending Date: 3/31/2011 Detail Page 2 of 2 Pages
Item ID Description Total Previously Work Presently Completed a/, Balance Retainage
Contract Completed Completed Stored And Stored Comp To Balance
Amount Work This Materials To Date Finish
Period
01 CHANDELIER CT.FOUNTAIN 62,035.00 15,508.75 15,508.75 31,017.50 50.00 31,017.50 3,101.76
•
Totals 62,035.00 15,508.75 15,508.75 31,017.50 50.00 31,017.50 3,101.76
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 Theater Development Corp. to furnish certain labor, materials, and/or
services as follows: Misc. Construction for a project known as: SFC#11-010 City Center Chandelier
Ct.Fountain located at Cannel, IN and does hereby state on behalf of the aforementioned contractor:
(PARTIAL WAIVER)that there is due from the owner the sum of: ($13,957.87)
Thirteen Thousand Nine Hundred Fifty Seven Dollars and 87/100
[ ] receipt of which is hereby acknowledged;or
[X] the payment of which has been p•omised 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($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 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 -�4`/, ,4 "'=isle CEO
T.M. Fansler
WITNESS MY HAND AND NOTARIAL SEAL, this 21'' day of March , 2011.
i' ,(f
tvlelissa.l Bishop Notary"Public
r 1! ..,.
My commission expires November 30.2016 Residing in Morgan County
Check: .77 I Show: Current Register
To: 77 Checking Account: 1061141
Check Register Page 1
Carmel Redevelopment Comm 611111 13:32
6/1/201 1 Company:LO
Payable/ Workers
Check Check Date Vendor Number and Name Voucher Invoice Payroll Retention Cash Discount Comp.
77 4/8/2011 SMOCKFA1 Smock Fansler Corporation 9651 3106 13,957.87 0.00 -13,957.87 0.00 0.00
G/L Apr,2011 2910 W Minnesota Street 9655 3107 37,528.65 0.00 -37,528.65 0.00 0.00
Indianapolis,IN 46241-4541 51,486.52 0.00 -51,486.52 0.00 0.00
51,486.52 0.00 -51,486.52 0.00 0.00
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES2 -
TO OWNER CRC at City of Carmel PROJECT: Parcel 5 Fountains APPLICATION NO Invoice;t 2 1 Distribution to:
Carmel Indiana 46032 Signature costs OWNER
ARCHITECT
PERIOD TO: 3/25/2011 X CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Construction Services LLC
720 3rd Avenue S.W. PROJECT NOS:
Carmel, Indiana 46032
CONTRACT FOR: CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been
Continuation Sheet,AIA Document G703,is attached. 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.
I. ORIGINAL CONTRACT SUM $ 6,203.50
2. Net change by Change Orders $ 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1±2) $ 6,203.50
4. TOTAL COMPLETED St STORED TO $ 1,550.88 i _
By: 7 Date: 3/Z )/
5. RETAINAGE: Thom :Koontz,President /
a. 0 %of Completed Work $ 0 (tbscribed ay. sworn to before me this >'>_ day of 3////
(Column D+E on G703) `
b. %of Stored Material $ / rN LINDA BUC County
` uolnav�,_ Hancock County
(Column F on G703) t '.,..se; My Commission Expires
Total Retainage(Lines 5a+5b or '{i /.. August 20,2011
Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT'--
6. TOTAL EARNED LESS RETAINAGE $ 1,550.88 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated,
PAYMENT(Line 6 from prior Certificate) $ 775.44 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 775.44 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 4,652.63
(Line 3 less Line 6) AMOUNT CERTIFIED $ -)7 !4
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified diff:rs from the amount applied. Initial all figures on tins
Total changes approved Application and onthe Cant' a ii 't fiat are ch ,d to co orm iv h the cnnou it certified.)
in previous months by Owner ARCHITECT: '� Al 3 3(14
Total approved this Month By: MAW WI Date: 4 5- A
TOTALS $0.00 $0.00 This Certificate is .t ncgntiabl-. The AMOUNT CERTIFIED is payable onl to th
Contractor named ne in ssuance,payment and acceptance of payment arc without
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract,
AIA DOCUMENT G702'APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. Q(/
Director of Redevelopment/ y to o 805 '\
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 2
3/25/11
Parcel 5 Fountains
Carmel, Indiana
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed
NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost
General Requirements:
Site Supervision 3,101.75 0.00 0.00 0.00 0.00 0% 3,101.75 0.00
Construction Management Fee 3,101.75 775.44 775.44 0.00 1,550.88 50% 1,550.88 1,550.88
6,203.50 775.44 775.44 0.00 1,550.88 25% 4,652.63 1,550.88
CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN
STATE OF INDIANA
COUNTY OF HAMILTON )
Thomas E. Koontz being duly sworn states that he is the President of Signature
Construction, LLC having contract to furnish certain materials and /or labor as
follows: Construction Management Services for a project known as
Parcel 5 Fountains, located at Carmel, Indiana and owned by the
Carmel Redevelopment Commission and does state:
CONDITIONAL WAIVER:
that the balance due from the owner is the sum of
seven hundred seventy-five dollars and forty-four cents ($775.44) the
payment of which has been promised as the sole consideration for this Affidavit
and Conditional Waiver of Lien which is given to and for said amount, effective
upon receipt of such cash payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any
and all line or claim whatsoever on the above-described property and improvements
thereon on account of labor or material or both, furnished by the undersigned thereto, and
further certifies that no other party has any claim or right to a lien on account of any
work perform or material furnished to the undersigned for the said project, and within the
scope of this affidavit and waiver.
SIGNATURE CONSTRUCTION, LLC
Thomas /Koontz, President
Subscribed and sworn to before me this: '//0 ///
Notary Public:. -/„
a _'e LINDA BUCHANAN
NoTARI Hancock County
se/1 My Commission Expires ,
August 20,2011
Decorative Fountains
(Signature)
February 2011
Application 1
Paid by Carmel Theater Development $ 775.44
March 2011
Application 2
Amount to be paid by Carmel Theater Development $ 775.44
Check 74 Show: Current Register
To: 74 I Checking Account: 1061141
Check Register Page 1
Carmel Redevelopment Comm 611111 13:28
6/1/2011 Company:LO
Payable/ Workers
Check Check Date Vendor Number and Name Voucher Invoice Payroll Retention Cash Discount Comp.
74 4/8/2011 SIGNATO1 Signature Construction,LLC 9649 4-3 6,824.47 0.00 -6,824.47 0.00 0.00
G/L Apr,2011 720 3rd Ave.,SW 9650 10-2 775.44 0.00 -775.44 0.00 0.00
Carmel,IN 46032 9654 11-2 2,084.93 0.00 -2,084.93 0.00 0.00
9,684.84 To -9,684.84 0.00 0.00
9,684.84 0.00 -9,684.84 1100 1100