HomeMy WebLinkAboutSmock Fansler, Signature - $15,205.48Regions 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
Pay application 4 (Smock Fansler) May 2011
$ 11,166.30
Pay application 3 (Signature) May 2011
$ 4,039.18
Total Authorized Disbursement
$ 15.205.48
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: G 27/(
CITY OF CARMEL REDEVELOPMENT
COMMISSION
By:
Printed:
Title:
Les S. Olds
Executive Director
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
Paid by Carmel Theater Development $ 13,957.87
April 2011
Application 3
Paid by Carmel Theater Development $ 5,583.16
May 2011
Application 4
Amount to be paid by Carmel Theater Development $ 11,166.30
AIA Type Document
Application and Certification for Payment
Page 1 of 2
TO (OWNER): CARMEL THEATER DEV CORP
11711 N. PENNSYLVANIA ST.
CARMEL, IN 46032
FROM (CONTRACTOR): Smock Fansler Corporation
2910 W. Minnesota Street
Indianapolis, IN 46241
CONTRACT FOR:
PROJECT: CITY CTR. CHANDELIER CT. FOUNT
30 W. MAIN ST.
CARMEL, IN 460 2
VIA (ARCHITECT):
ECEI ° ED
MAY2 $ 2011
Per
APPLICATION NO: 4
PERIOD TO:5/31/2011
ARCHITECT'S
PROJECT NO:
CONTRACT DATE:
DISTRIBUTION
TO:
_ OWNER
_ ARCHITECT
_ CONTRACTOR
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for Payment, as shown below, in connection with the Contract.
Continuation Sheet, AIA Type Document is attached.
1. ORIGINAL CONTRACT SUM $
2. Net Change by Change Orders $
3. CONTRACT SUM TO DATE (Line 1 + 2) $
4. TOTAL COMPLETED AND STORED TO DATE $
62,035.00
0.00
62,035.00
49,628.00
5. RETAINAGE:
a. 10.00 % of Completed Work $ 4,962.80
b. 0.00 % of Stored Material $ 0.00
Total retainage (Line 5a + 5b)
6. TOTAL EARNED LESS RETAINAGE $
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate) $
4,962.80
44,665.20
33,498.90
8. CURRENT PAYMENT DUE $
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) $ 17,369.80
11,166.30
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
0.00
0.00
Total approved this Month
0.00
0.00
TOTALS
0.00
0.00
NET CHANGES by Change Order
0.00
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
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 \\tktatoWUiuuuu; / / / \\, �//
current payment shown herein is now due. �( PUBS /C' %ii/,,
CONTRACTOR: Smock Fansler Corporation
2910 W. Minnesota Street Indianapolis, IN 46241
By:
T.M. Fansler
State of: IN
County of: MORGAN
Subscribed and Sworn to before me this
/ CEO
Notary Public:
Date:
My Commission Expires : /// 6 72
P
ATE OF �N�\P�\\ \\
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Day of
20 /(
ARCHITECT'S CERTIFICATE FOR PAYMENT
In Accordance with the Contract Documents, based on on -site observations and the data com-
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
is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
AMOUNT CERTIFIED.
AMOUNT CERTIFIED
(Attach explanation if amount certifie• ,differs from the amount applied. Initial all figures on this
►. 0-- eel, that are changed to conform to the amount certified.)
ii'I
il4
Application and on th
ARCHITECT:
By:
Date:
This Certificate is •ot negotiable. The AMOUNT CERTIFIED is pa -ble on 'to the Contractor
named herein. Issuance, Payment and acceptance of payment - - ' ithout prejudice to any
rights of the Owner or Contractor under this Contract.
5,3rfp
AIA Type Document
Application and Certification for Payment
Page 2 of 2
TO (OWNER): CARMEL THEATER DEV CORP
11711 N. PENNSYLVANIA ST.
CARMEL, IN 46032
FROM (CONTRACTOR): Smock Fansler Corporation
2910 W. Minnesota Street
Indianapolis, IN 46241
CONTRACT FOR:
PROJECT: CITY CTR. CHANDELIER CT. FOUNT
30 W. MAIN ST.
CARMEL, IN 46032
VIA (ARCHITECT):
APPLICATION NO: 4
PERIOD TO:5/31/2011
ARCHITECTS
PROJECT NO:
CONTRACT DATE:
DISTRIBUTION
TO:
_ OWNER
_ ARCHITECT
CONTRACTOR
ITEM DESCRIPTION
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1
CHANDELIER CT. FOUNTAIN
62,035.00 37,221.00 12,407.00 0.00 49,628.00 80.00 12,407.00 4,962.80
REPORT TOTALS $62,035.00
$37,221.00 $12,407.00 $0.00 $49,628.00 80.00 $12,407.00 $4,962.80
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 Carmel, IN and does hereby state on behalf of the aforementioned contractor:
(PARTIAL WAIVER) that there is due from the owner the sum of: ($11,166.30)
Eleven Thousand One Hundred Sixty Six Dollars and 30/100
[ ] receipt of which is hereby acknowledged; or
[X] the payment of which has been promis d 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 effectiw 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 'k?"' /7 ,�� le CEO
T.M. Fansler
WITNESS MY HAND AND NOTARIAL SEAL, this 19th day of May , 2011.
zet
Melissa J. Bish p Nota/
My commission expires November 30, 2016
.�P��mPUB4 /"
'-
• Residing in Morgan County S7- ATE / ofj1N0Po�`
Decorative Fountains
(Signature)
February 2011
Application 1
Paid by Carmel Theater Development $ 775.44
March 2011
Application 2
Paid by Carmel Theater Development $ 775.44
May 2011
Application 3
Amount to be paid by Carmel Theater Development $ 4,039.18
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT 6702
PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Parcel 5 Fountains
Carmel Indiana 46032
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Construction Services LLC
720 3rd Avenue S.W.
Carmel, Indiana 46032
CONTRACT FOR:
APPLICATION NO Invoice # 3 1 Distribution to:
Signature costs OWNER
ARCHITECT
PERIOD TO: 5/23/2011 CONTRACTOR
PROJECT NOS:
CONTRACT DATE:
X
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract.
Continuation Sheet, AIA Document G703, is attached.
1. ORIGINAL CONTRACT SUM
2. Net change by Change Orders
3. CONTRACT SUM TO DATE (Line 1 t 2)
4. TOTAL COMPLETED & STORED TO
5 RETAINAGE
a. 0 % of Completed Work
(Column D + E on G703)
b % of Stored Material $
(Column F on G703)
total Retainage (Lines Sa + Sb or
Total in Column I of 0703)
6 TOTAL EARNED LESS RETAINAGE
(Line 4 Less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$ 6,203.50
$ 0.00
$ 6,203.50
$ 5,590 06
$ 0
$ 0.00
$ ),590.06
1,550.88
4,039.18
613.44
CHANGE ORDER SUMMARY
ADUI I IONS
DEDUC I IONS
Total changes approved
in previous months by Owner
Total approved this Month
TOTALS
$0.00
$0.00
NET CHANGES by Change Order
$0.00
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 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.
CONTRACTOR:
By:
'1 homa f oontz, 'resl.ent
Sub cribed and worn to before me this
Date:
day of /Ytayr ap/f
NOTARY
LINDA BUCHANAN
Hancock County
My Commission Expires
August 20, 2011
In accordance with the Contract Documents, based on on -site observations and the data
comprising the application, the Architect certifies to the Owner that to the best of the
Architects knowledge, information and belief the Work has progressed as indicated,
the quality of the Work is in accordance with the Contract Documents, and the Contractor
is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED
(Attach expianatio
Application and
ARCHITECT:
By:
f anon
nthe Con
$ g-e D39.18
certified differs from the amount applied. Initial all figures on this
Haan t that are changed to conform with the amount certified.)
0 Date:
/3rfq
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
contractor namea nerem. issuance, payment ana acceptance or payment are wunout
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION ' AIA C1992 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.
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 3
5/23/11
Parcel 5 Fountains
Carmel, Indiana
ITEM
NO.
DESCRIPTION OF
WORK
SCHEDULED
VALUE
WORK COMPLETED
MATERIALS
PRESENTLY
STORED
TOTAL
COMPLETED AND
STORED TO DATE
%
BALANCE
TO
FINISH
Committed
Cost
FROM PREVIOUS
APPLICATIONS
THIS
PERIOD
General Requirements:
Site Supervision
Construction Management Fee
3,101.75
3,101.75
0.00
1,550.88
2,983.96
1,055.22
0.00
0.00
2,983.96
2,606.10
96%
84%
117.79
495.65
2,983.96
2,606.10
6,203.50
1,550.88
4,039.18
0.00
5,590.06
90%
613.44
5,590.06
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 four thousand
thirty -nine dollars and eighteen cents ($4,039.18) 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
f
Thomas E. Koons, President
Subscribed and sworn to before me this: 4 y a� ,.10i/
Notary Public:
NOTARY'.
SEAL '
'•. � OF �NO� �:
LINDA BUCHANAN
Hancock County
My Commission Expires
August 20, 2011