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HomeMy WebLinkAboutSmock Fansler, Signature - $14,239.85Regions 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 6 (Smock Fansler) July 2011 $ 13,045.41 Application 4 (Signature) July 2011 $ 1,194.44 Total Authorized Disbursement $ 14,239.85 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: 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 Paid by Carmel Theater Development $ 11,166.30 June 2011 Application 5 Paid by Carmel Theater Development $ 3,349.89 July 2011 Application 6 Amount to be paid by Carmel Theater Development $ 13,045.41 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 VV. Minnesota Street Indianapolis, IN 46241 CONTRACT FOR: PROJECT: CITY CTR. CHANDELIER CT. FOUNT 30 W. MAIN ST. CARMEL. IN 46032 VIA (ARCHITECT): APPLICATION NO: 6 PERIOD TO:7/31/2011 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 $ 5. RETAINAGE: a. 10.00 % of Completed Work b. 0.00 % of Stored Material Total retainage (Line 5a + 5b) 62,035.00 5.810.00 67.845.00 67,845.00 6,784.50 0.00 6. TOTAL EARNED LESS RETAINAGE. (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Cer tificate) $ 8. CURRENT PAYMENT DUE $ 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 6,784.50 6,784.50 61,060.50 48,015.09 13,045.41 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 0.00 0.00 Total approved this Month 5 810.00 0.00 TOTALS 5.810.00 0.00 NET CHANGES by Change Order 5,810.00 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: Smock Fansler Corporation 2910 W. Minnesota Street Indianapolis. IN 46241 By: r°t T.M. Fansler State of: IN County of: MARION Subscribed and Sworn to before me this i CEO Notary Public: Date: rr 2 rr f Day of 'N\1(/ C. y 20 JJ z1 C - ,f!.('2'.. `G kc rah C= fl l c My Commission Expires : 1..._� ARCHITECT'S CERTIFICATE FOR PAYMENT In Accordance with the Contract Documents. based on on -site cbservaticns r,,nd the ;iata corn - prising the above application, the Architect certifies to owner that 10 the best of the Arcli6tect's knowledge, information and belief the Work has progressed as irrlicated,th quality of the work is in accordance with the Contract Documents, and the Contractor is eni;tled to pay:nent of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $ , 1�`�� 4 (Attach explanation if . int edified differs from the amount applied. ;citint e/ ; l/gures on this Application and or ARCHITECT: By: Sheet that are changed to conform to the amount certified.) Dale: 1129-)L This Certificate is no negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein -1 nce. Payment and acceptance of payme are without prejudice to any rights of the Owner or Contractor under this Contract. 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 APPLICATION NO: 6 PERIOD TO:7/31/2011 VIA (ARCHITECT): ARCHITECTS PROJECT NO: CONTRACT DATE: DISTRIBUTION TO: _ OWNER _ ARCHITECT CONTRACTOR SCHEDULE • PREVIOUS COMPLETED STORED COMPLETED ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED BALANCE RETAINAGE 1 2 CHANDELIER CT. FOUNTAIN 62,035.00 53,350.10 8,684.90 0.00 62,035.00 100.00 0.00 6,203.50 REDESIGN, PIPE UPSIZE, 5,810.00 0.00 5,810.00 0.00 5,810.00 100.00 0.00 581.00 STONE CHANGE REPORT TOTALS $67,845.00 $53,350.10 $14,494.90 $0.00 $67,845.00 100.00 $0.00 $6.784.50 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 CORI'. 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: (513,045.41) Thirteen Thousand Forty Five Dollars and 41/100 [ ] 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 sum of (50.00) [ ] 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 " �' • � ..- ,�, .Ti {le CEO T.vir�Fansler WITNESS MY HAND AND NOTARIAL SEAL, this,, 21'h day of July , 2011. /- Glenda C. Hill Notary Public My commission expires November 15, 2014 Residing in Marion_ County 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 Paid by Carmel Theater Development $ 4,039.18 July 2011 Application 4 Amount to be paid by Carmel Theater Development $ 1,194.44 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER CRC at City of Carmel PROJECT: Parcel 5 Fountains Carmel Indiana 46032 FROM CONTRACTOR: Signature Construction Services LLC 720 3rd Avenue S.W. Carmel, Indiana 46032 CONTRACT FOR: VIA ARCHITECT: Pcdcor Design APPLICATION NO Invoice a 4 1 Distribution to: Signature costs OWNER ARCHITECT PERIOD TO: 7/21/2011 X CONTRACTOR PROJECT NOS: CONTRACT DATE: 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 ± 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 5a + 5b or Total in Column 1 ofG703) 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) $ 6,784.50 0.00 6,784.50 6,784.50 $ 0 $ $ 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: mas E. .o tz, President Subsw bed and swo to before me this as ' /day of J ady,potJ Date: 7/ S/l/ nar PCB; NOTARY c f.. SEAL 2 LINDA BUCHANAN Hancock County My Commission Expires August 20, 2011 o.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6,784.50 5,590.06 1,194.44 0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS $0.00 $0.00 NET CHANGES by Change Order $0.00 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 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 certified differs from the amount applied. Initial all figures on this e Continuation Sheet that are changed to conform with the amount certified.) Application and o ARCHITECT: N By: This Cc tificate is Lontrac\or nameo prejudice o any rig Date: Z 2� t `Y �eptiable. The AMOUNT CERTIFIED is payab only to the m . issuance, payment and acceptance of payment are wit iout re is of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA ©1992 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 fro ie Licensee. /C, 7/vilff SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 4 7/21/11 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 3,392.25 3,392.25 2,983.96 2,606.10 408.29 786.15 0.00 0.00 3,392.25 3,392.25 100% 100% 0.00 0.00 3,392.25 3,392.25 6,784.50 5,590.06 1,194.44 0.00 6,784.50 100% 0.00 6,784.50 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 one thousand one hundred ninty -four dollars and forty -four cents ($1,194.44) 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 Thr as E. ontz, President Subscribed and sworn to before me this: AR J idy,59 / Notary Public: LINDA BUCHANAN Hancock County My Commission Expires August 20, 2011