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Home My WebLink AboutSmock Fansler - $3,349.89Regions 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 5 (Smock) June 2011 $ 3,349.89 Total Authorized Disbursement $ 3,349.89 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: 7A, // 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 Amount to be paid by Carmel Theater Development $ 3,349.89 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 46032 VIA (ARCHITECT): APPLICATION NO: 5 PERIOD TO:6/30/2011 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. 62,035.00 0.00 62,035.00 53,350.10 $ 5,335.01 0.00 % of Stored Material $ Total retainage (Line 5a + 5b) 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. Minneso - Street Indianapolis, IN 46241 By: v T.M. Fansler State of: IN County of: MORGAN / CEO 0.00 Subscribed and Sworn to before me this 5,335.01 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) $ 14,019.91 48, 015.09 44,665.20 3,349.89 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 Notary Public: Date: j1 My Commission Expires : ///..1)/..:2(4)//2 ip.l.�UQ4 cz, Day of Ji /,1!, 20 if 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 $ '3)4c1 e (Attach explanation if amou t certified differs from the amount applied. Initial all figures on this Application and nuation Sheet that are changed to conform to the amount certified.) ARCHITECT: By: Date: qa4V • This Cell' negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. ssuance, Payment and acceptance of payment are wi ut pre' dice to any rights of the Owner or Contractor under t ' Contract. / C" - tYCI G o ri Opt AIA Type Document Application and Certification for Payment Page 2 of 2 TO (OWNER):CARMELTHEATER 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: 5 PERIOD TO:6/30/2011 ARCHITECT'S PROJECT NO: CONTRACT DATE: DISTRIBUTION TO: _ OWNER _ ARCHITECT CONTRACTOR SCHEDULE PREVIOUS COMPLETED STORED COMPLETED ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED ova BALANCE RETAINAGE 1 CHANDELIER CT. FOUNTAIN 62,035.00 49,628.00 3,722.10 0.00 53,350,10 86.00 8,684.90 5,335.01 REPORT TOTALS $62,035.00 $49,628.00 $3,722.10 $0.00 $53,350.10 86.00 $8,684.90 $5,335.01 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: ($3,349.89) Three Thousand Three Hundred Forty Nine Dollars and 89/100 [ ] receipt of which is hereby acknowledged; or [XJ the payment of which has been promed 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 WITNESS MY HAND AND NOTARIAL SEAL, this ,,17`h day of June , 2011. /%E% {44?/t c (;,) Melissa J. Bishop Notary Public My commission expires November 30, 2016 Residing in Morgan County