HomeMy WebLinkAboutSmock Fansler - $6,784.50Regions 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 7 (Smock) August 2011
$ 6,784.50
Total Authorized Disbursement
$ 6,784.50
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 Bar and Carmel Theater Development Company, LLC.
Dated: `F
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
Paid by Carmel Theater Development $ 13,045.41
August 2011
Application 7
Amount to be paid by Carmel Theater Development $ 6,784.50
AIA Type Document
Application and Certification for Payment
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):
.off
.&.
APPLICATION NO: 7 A G D
RIBUTION
el. O c t0,oi PERIOD TO:8/31/2011
Page 1 of 2
ARCHITECTS
PROJECT NO:
CONTRACT DATE:
<2� //_ 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. 0.00 % of Completed Work
b. 0.00 % of Stored Material $
62,035.00
5,810.00
67,845.00
67,845.00
0.00
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) $
8. CURRENT PAYMENT DUE $
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) $
0.00
67,845.00
61,060.50
6,784.50
0.00
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
5,810.00
0.00
Total approved this Month
0.00
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. \�IIIIIPIU'B4�C
O
CONTRACTOR: Smock Fansler Corporation
2910 W. Minnesota Street Indianapolis, IN 46241
By:
T.M. Fansler
State of: IN
County of: MARION
Subscribed and Sworn to before me this
/ CEO
Notary Public: /
My Commission Expires :
Date:
/! % %0/6
Day of
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 certified differs from the amount applied. Initial all figures on this
Application and on th= onti u. on heet that are changed to conform to the amount certified.)
ARCHITECT:
By: -►,�,• Date:
2)-q)1
This Certifi te is no negotiable. The AMOUNT CERTIFIED is payable only to the ontrac
named herein. ance, Payment and acceptance of payment are without pre ...- to ayr�(
rights of the Owner or Contractor under this Contract.
CA1
WasAr
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: 7
PERIOD TO:8/31/2011
ARCHITECT'S
PROJECT NO:
CONTRACT DATE:
DISTRIBUTION
TO:
_ OWNER
_ ARCHITECT
CONTRACTOR
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1
2
CHANDELIER CT. FOUNTAIN 62,035.00 62,035.00 0.00 0.00 62,035.00 100.00 0.00 0.00
REDESIGN, PIPE UPSIZE, 5,810.00 5,810.00 0.00 0.00 5,810.00 100.00 0.00 0.00
STONE CHANGE
REPORT TOTALS
$67,845.00 $67,845.00
$0.00 $0.00
$67,845.00 100.00
$0.00 $0.00
AFFIDAVIT AND WAIVER OF LIEN
[X] Final [ ] 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: ($0.00)
[ ] receipt of which is hereby acknowledged; or
[ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waver 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 ($6,784.50)
Six Thousand Seven Hundred Eighty Four Dollars and 50 /100
[ ] receipt of which is hereby acknowledged; or
[X] 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 v' ��. 414-41-1-4■•--Title CEO
T.M. Fansler
WITNESS MY HAND AND NOTARIAL SEAL, this 5th day of August , 2011.
My commission expires November 30, 2016
Y4r
zrnL c&/
Melissa J. Bishop Not�ry Public
\\PRYtuPnUsz /c
Residing in Morgan County STgTEOF • .
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