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Ermco - $1,825.65
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 Café Improvements installment purchase contract Application 2(ERMCO) April 2011 $ 1,825.65 Total Authorized Disbursement $ 1,825.65 All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Equipment and Improvements), dated July 22, 2010, by and between Regions Bank and Carmel Theater Development Company, LLC. Dated: 6/1/ CITY OF CARMEL REDEVELOPMENT COMM ISSION By: 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. Draft Cafe Improvements (Ermco) December 2010 (application 1) Paid by the Carmel Theater Development Company $ 34,687.35 April 2011 (application 2) Amount to be paid by the Carmel Theater Development Company $ 1,825.65 j APPLICATION FOR PAYMENT ! Construction Manager Version CAP702 Page:1 of 2 To: PROJECT; Via Construction Manager, 124070.701 Retainage Carmel Theater Development Co LLC 1240708 11711 N. Pennsylvania St Carmel RPAC Cafe Buildout I Application No.: Application Date: Period To: Contract Date: Suite 200 Electrical Agreement#2695-02605 Carmel,IN 46032 2 APR 6,2011 APR 6,2011 , Project Nos: From Contractor VI■ARCHrTECT ERMCO INC I Distribution List ❑ Owner ❑ Construction Mgr P.O. BOX 1507 I ❑ Architect ❑ Field INDIANAPOLIS, IN 46206 I Lj Contractor [7 Other CONTRACT FOR: Electrical Contractor's Application for Payment CONTRACTOR'S CERTIFICATION: Application is made for payment as shown below,with attached Continuation Sheet. The Contractor's signature here certifies that,to the best of their knowledge, 1.Original Contract Amount: $ 36,513.00 this document accurately reflects the work completed in this Application for Payment.The Contractor also certifies that all payments have been made 2. Net of Change Orders: $ 0.00 for work on previous Applications for Payment an also that the Current 3.Net Amount of Contract: $ 36,513.00 Payment is Due. 4.Total Completed&Stored to Date: $ 36,513.00 (Authorizing Signatur- / �! J J 7/�- -M6O,INb-- $�' 5.Retainage Summary: APR 6,2011 kb, a. 5.00 %of Completed Work $ 0.00 Date: } p State Authorized: Indiana $ 0.00 County of � 46 b. 0.00 %of Stored Material y Marion Subscribed and sworn to before D . d 0 3IJ Total Retainage: $ 0.00 me this 6th day of pril,2 n y:� , . %" °�© A. 6.Total Completed Less Retainage: $ 36,513.00 Notary Public: (l Yy x� 1� '1,' My Commission expires: December 19,2015 1., 7. Less Previous Applications: $ 34,687.35 l' CONSTRUCTION MANAGER'S&ARCHITECT'S CE i !CATION: 8.Current Payment Due,This Application: $ 1,825.65 ' The Construction Manager's& Architects signature here certifies that, _-____ __..._ ____.. __._____..._ based on their own observations,the Contract Documents and the information contained herein,this document accurately reflects the work completed 9.Contract Balance(Including Retainage): $ 0.00 in this Application for Payment.The Constru..•n M.:nager&Architect — ------ rCNANGE ORDER Activity ; also certifies tie Contract r is entitledb3t•- amou certified for payment. Additions - . Subtractions Total previously approved: 0.00 j 0.00 AMOUNT Ca IFIER: Ill • iS Total approved this Month: 0.00 0.00 �..∎!..,1� , •7i_.._ . _ ._% /' Date: 0••nstrucha• .."a:Ir(Sign- j Sub Totals: 0.00 0.00 , ' �, �� t t { NET of Change Orders: . 0.00 �!�� Date: • Archit- (Sign p • Software by:PEM Softvware Systems,inc. 1.8GO-803-1315 Copyright 20x•7© j APPLICATION FOR PAYMENT - CONTINUATION SHEET CAP703 Page 2 of 2 Pages From: To: Project: 1 Application No: 2 ERMCO, INC Carmel Theater Development Co LLC 124070R i Application Date: 4/06/2011 P.O. BOX 1507 11711 N. Pennsylvania St Carmel RPAC Cafe Buildout Period To: 4/06/2011 INDIANAPOLIS, IN 46206 Suite 200 Electrical Agreement#2695-02605 Carmel, IN 46032 Contract Date: / / Architects Project#: A B C D E Work Completed Materials Total Completed ° Balance • Retainage Item Description of Work Contract From Previous This Period Presently and Stored �° To Finish (If Variable No • Value Application Stored(Not In To Date (G/C) (C-G) Rate) (0+E) D or E) (D+E+F) 1 CONTRACT AMOUNT 36,513.00 36,513.00 0.00 0.00; 36,513.00 100 0.00 0.00 ' I ' • I i j . i ' j I i l I 36,513.00 I 36,513.00 0.00 0.00 36,513.00 100 0.00 0.00 1 Software by:PEM Software Systems,Inc. 1-500-303-1315 Copyright 2007@ AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA ) Final X Partial )SS: COUNTY OF MARION ) Rod Burton being duly sworn states that he is the Controller of ERMCO, INC.having contracted with Carmel Theater Development Co LLC (124070.701) to furnish certain materials and/or labor as follows: Electrical Installation for a project known as Carmel RPAC Cafe Buildout Electrical Agreement #2695-02605 located in Carmel,IN and does further state: PARTIAL WAIVER: That the balance due from the owner is the sum of the receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount,effective upon receipt of such payment: FINAL WAIVER: That the final balance due from the owner is the sum of ONE THOUSAND EIGHT HUNDRED TWENTY FIVE DOLLARS AND 65/100($1,825.65) receipt of which is hereby acknowledged: or x the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien and 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 performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. ERMCO,INC.. / by C� �J Rod Burton Controller VNIn Witness my hand and notarial seal,this 611' day of April,2 1Q riy-yv\ fr--,--e- 044- _ __,Notary Public )cf.. � Q My Commission Expires: 12/19/2015 Lou Anne Puckett v- SON Notary Public-Printed Signat County of Residence: Marion ul yk fr n0i