HomeMy WebLinkAboutSignature, Smock Fansler - $17,668.45 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 City Center
Drive/Range Line Road Streetscape Improvements installment purchase
contract
Application 13(Smock Fansler) July 2011 $ 16,790.40
Application 18(Signature) July 2011 $ 878.05
Total Authorized Disbursement $ 17,668.45
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 Natio al Bank of Indianapolis and Carmel Theater Development Company, LLC.
Dated: 877 h CITY OF CARMEL REDEVELOPMENT
COMMISSION
By:
Les S. Olds
Printed:
Executive Director
Title:
P73 Hardscape
(Smock Fansler)
July 2010
Application 1
Paid by Carmel Theater Development $ 64,998.00
August 2010
Application 2
Paid by Carmel Theater Development $ 77,697.00
September 2010
Application 3
Paid by Carmel Theater Development $166,914.00
October 2010
Application 4
Paid by Carmel Theater Development $309,289.50
November 2010
Application 5
Paid by Carmel Theater Development $238,590.00
December 2010
Application 6
Paid by Carmel Theater Development $ 70,164.00
January 2011
Application 7
Paid by Carmel Theater Development $ 56,929.50
February 2011
Application 8
Paid by Carmel Theater Development $ 65,706.75
March 2011
Application 9
Paid by Carmel Theater Development $ 52,728.75
April 2011
Application 10
Paid by Carmel Theater Development $ 58,639.50
May 2011
Application 11
Paid by Carmel Theater Development $ 25,848.00
June 2011
Application 12
Paid by Carmel Theater Development $ 6,300.00
July 2011
Application 13
Amount to be paid by Carmel Theater Development $ 16,790.40
A1A Type Document
Application and Certification for Payment Page 1 of 3
TO(OWNER):CARMEL THEATER DEVELOPMNT CORP PROJECT:CARMEL PARCEL 73 HARDSCAPE APPLICATION NO: 13 DISTRIBUTION
11711 N. PENNSYLVANIA ST. TO:
CARMEL, IN 46032 PERIOD TO:7/31/2011 _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:
CONTRACTOR'S APPLICATION FOR PAYM ENT 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 $ 1,251,450.00
2.Net Change by Change Orders $ 93,656.01 CONTRACTOR: Smock Fansler Corporation
2910 W.Minnesota Street Indianapolis, IN 46241
3.CONTRACT SUM TO DATE (Line 1 +2) $ 1,345.106.01 ! �/�/ f
4.TOTAL COMPLETED AND STORED TO DATE $ 1,345,106.01 By: fit,../f'/74 -->--4517�✓7,�.tAI��a�f,,. Date: 7/4. ! /711
T.M.FANLER i CEO Y
5.RETAINAGE: State of:IN
a. %of Completed Work $ 134.510.61
____10.00 County of: MARION _
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this '2,L l_h Day of , rLf L.'7 20 s1
Total retainage(Line 5a+5b) $ 134,510.61 Notary Public: y, . 'iL:a) L C. ��r Q� 61..t . i�r1 c. J�tf/
My Commission Expires:f 1,-15—r/'I- _^J_
6.TOTAL EARNED LESS RETAINAGE $ 1,210,595,40 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 less Line 5 Total)
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site chserratio re and the data::orn-
Line 6 from prior Certificate) $ 1,193,805.00 prising the above application, the Architect certifies to owner that to the bsst of the Architects
( P knowledge,information and belief the Work has progressed as tndlcated,`.hec;u°.1ity of the work
8.CURRENT PAYMENT DUE $ 16,790.40 is in accordance with the Contract Documents. and the Contractor is entitled to peiymcni of she
AMOUNT CERTIFIED. I
9.BALANCE TO FINISH,INCLUDING RETAINAGE �� �Q�'�
(Line 3 less Line 6) $ 134,510.61 AMOUNT CERTIFIED v'��r-'...
(Attach explan. (on if,mou e Vied differs from the amount applied. Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application a d on 1/ Co Gnua ion that are changed to conform to the amount certified.)
Total changes approved in ARCH ITE• : / ' Z� t/
previous months by Owner 75,000.00 0.00 By: �,/ Date: f
Total approved this Month 18,656.01 0.00 This Certificate is not negotiahle. The AMOUNT CERTIFIED is payable only to the Contractor
named herein.Issuance.Payment and acceptance of payment are without prejudice to any
TOTALS 93.655.01 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 93.656.01
LW._,.<2.e4,---k..7__. 94-1-ill
,
—is
AIA Type Document '
Application and Certification for Payment Page 3 of 3
TO(OWNER):CARMEL THEATER DEVELOPMNT CORP PROJECT:CARMEL PARCEL 73 HARDSCAPE APPLICATION NO: 13 DISTRIBUTION
11711 N.PENNSYLVANIA ST. TO:
CARMEL,IN 46032 PERIOD TO:7/3 112 01 1 _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
22 CHANGE ORDER#8 6,825.00 6,825.00 0.00 0.00 6,825.00 100.00 0.00 682.50
23 Veneer Falswork for Pavers at 3,500.00 0.00 3.500.00 0.00 3,500.00 100.00 0.00 350.00
entry
24 Topsoil and Irrigation for NE 12,430.00 0.00 12,430.00 0.00 12,430.00 100.00 0.00 1,243.00
Planter
25 Bond Increase 2,726.01 0.00 2,726.01 .0.00 2,726.01 100.00 0.00 272.61
REPORT TOTALS $1,345,106.01 $1,326,450.00 $18,656.01 $0.00 $1,345,106.01 100.00 $0.00 $134,510.61
•
•
AFFIDAVIT AND WAIVER OF LIEN
[ ) Final IX] 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 410-052 Cannel Parcel 73
Hardscape 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: ($16,790.40)
Sixteen Thousand Seven Hundred Ninety Dollars and 40/100
[ j 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 owner is the sun? 0160.00).
( ) 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 ��� L—Title CEO
.11. M. Fansler
WITNESS MY HAND AND NOTARIAL SEAL. this 21"' day of July, 2011.
--/-tom/ ICJ C /? 'C..t-�
Glenda C. Hill Notary Public
My commission expires November 15, 2014 Residing in Marion County
P73 Streetscape
(Signature Construction)
April 2010
Application 4
Paid by Carmel Theater Development $ 7,382.79
May 2010
Application 5
Paid by Carmel Theater Development $ 2,998.20
June 2010
Application 6
Paid by Carmel Theater Development $ 8,685.83
July 2010
Application 7
Paid by Carmel Theater Development $ 5,795.38
August 2010
Application 8
Paid by Carmel Theater Development $ 12,324.93
September 2010
Application 9
Paid by Carmel Theater Development $ 9,302 86
October 2010
Application 10
Paid by Carmel Theater Development.1_1750.11
November 2010
Application 11
Paid by Carmel Theater Development 5:12,155 )
December 2010
Application 12
Paid by Carmel Theater Development $ 4,185.75
January 2011
Application 13
Paid by Carmel Theater Development $ 3,381.34
February 2011
Application 14
Paid by Carmel Theater Development $ 6,737.31
March 2011
Application 15
Paid by Carmel Theater Development $ 7,360.79
April 2011
Application 16
Paid by Carmel Theater Development $ 3,324.75
May 2011
Application 17
Paid by Carmel Theater Development $ 1,840.75
July 2011
Application 18
Amount to be paid by Carmel Theater Development $ 878 05
•
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES 2
TO OWNER Carmel Theater Development Corp PROJECT: Carmel Parcel 73 APPLICATION NO Invoice ' p Distribution to:
Carmel Indiana 46032 Streetscape Signature costs OWNER
ARCHITECT
PERIOD TO: 7/21/2011 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 ofthe 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 $ 134,510.60
2. Net change by Change Orders $ 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1 ±2) $ 134,510.60
4. TOTAL COMPLETED&STORED TO $ 117,494.60
By: Date: 9/L //
5. RETAINAGE: '' om . oontz,President f
a. 0 %of Completed Work $ 0 Subsc ibed and vom to before me this day of J 4,249 Sr -f
'arP�•-• LINDA BUCHANAN
(Column D+12 on G703) ;_°:.. eff;.:
b. %of Stored Material $ _ •NOTARY ; Hancock County
(Column F on G703) ,N9.oE L ` My Commission Expires
Total Retainage(Lines 5a+5b or ` August 20,2011
Total in Column 1 of 0703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ 117,494.60 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) $ 116,616.55 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 878.05 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 17,016.00
(Line 3 less Line 6) AMOUNT CERTIFIED $ ES78.05
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanat• ' amount certified differs from the amount applied.Initial all figures on this
Total changes approved Application. d ont e Continuation Sheet that are changed to conform with the amount certified.) 1 0
in previous months by Owner ARCHI"I• T:
Total approved this Month 13y: '(.�✓ �---� Date: fft.liff
TOTALS $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 payment are without
NE"I'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 0401 -Certification of Documents Authenticity from the Licensee.
. 7,25
•-• ••• •
•
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 19
7/21/11
Parcel 73 Streetscape
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
Pre-Construction Services 0.00 4,481.93 0.00 0.00 4,481.93 0% (4,481.93) 4,481.93
General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Testing and Inspecting 2,500.00 1,052.89 0.00 0.00 1,052.89 42% 1,447.11 1,052.89
Site Supervision 53,005.30 44,204.48 0.00 0.00 44,204.48 83% 8,800.82 44,204.48
Construction Management 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00
Site Safety Director 500.00 500.00 0.00 0.00 500.00 100% 0.00 500.00
Design Drawings 3,000.00 0.00 0.00 0.00 0.00 0% 3,000.00 0.00
Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Temporary Lighting 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Office Supplies 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00
Temporary Fire Protection 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Temporary Water 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Tools and Equipment 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00 0.00
Projection Signage 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Field Eng. and Surveying 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00
Health and Safety 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
Waste Disposal 2,000.00 0.00 0.00 0.00 0.00 0% 2,000.00 0.00
Construction Management Fee 67,255.30 66,377.25 878.05 0.00 67,255.30 100% (0.00) 67,255.30
134,510.60 116,616.55 878.05 0.00 117,494.60 87% 17,016.00 117,494.60
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 73 Streetscape, located at Carmel, Indiana and owned by the
Carmel Theater Development Corporation and does state:
CONDITIONAL WAIVER:
that the balance due from the owner is the sum of
eight hundred severty-eight dollars and five cents ($878.05) 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
Tho s E. Kd' tz, President
Su cribed and sworn to before me this: ,91 J u/� Zo</
Notary Public: ,7‹. 64--41-
•
• LINDA BUCHANAN
Hancock County
�av.
5EA :,. My Commission Expires
August 20,2011