HomeMy WebLinkAboutSignature Construction, Smock Fansler - $50,952.30 t
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
Fountains installment purchase contract
Application 1 (Smock Fansler) February 2011 $ 48,270.60
Application 1 (Signature) February 2011 $ 2,681.70
i
M90.52.t30tw .• '
Total Authorized Disbursement �r�R� ��'� 4 ��' L A
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 B nk and Carmel Theater Development Company, LLC.
Dated: 3/!fir b( CITY OF CARMEL REDEVELOPMENT
COMMISSION
By: _7:73:Z .------
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.
Fountains
(Smock Fansler)
February 2011
Application 1
Amount to be paid by Carmel Theater Development $ 48,270:60
REQUEST FOR PAYMENT
From: Smock Fansler Corporation To: CARMEL REDEVELOPMENT COMMISSION Invoice: 3080
2910 W. Minnesota Street 30 W.MAIN ST. Draw: APP00001
Indianapolis, IN 46241-4541 CARMEL, IN 46032 Invoice date: 2/18/2011
Period ending date: 2/28/2011
Contract For
Request for payment:
Original contract amount $143,300.00
Approved changes $0.00 Project: 11005
Revised contract amount $143,300.00 CARMEL P.73 FOUNTAIN
Contract completed to date $53,634.00 Contract date:
Add-ons to date $0.00
Taxes to date $0.00
Architect:
Less retainage $5,363.40
Total completed less retainage $48,270.60 Scope.
Less previous requests $0.00
Current request for payment $48,270.60
Current billing $53,634,00
Current additional charges $0.00 .
Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Less current retainage $5,363.40 Changes approved in previous
Current amount due $48,270.60 months by Owner
Total approved this Month
Remaining contract to bill $95,029.40 TOTALS
NET CHANGES by Change Order
I hereby certify that the work performed and the materials supplied to date,as shown on the above represent the actual value of the accomplishment under the terms of the
Contract(and all authorized changes thereof)between the undersigned and the CARMEL REDEVELOPMENT COMMISSION relating to the above referenced project. I also
certify that the contractor has paid all amounts previously billed and paid by the owner.
t r^ r
CONTRACTOR: Smock Fansler Corporation State Of INDIANA County Of MORGAN
By 1:/ /1-7 r `��4r•-" 5-' day of r •r,.. /.11.:,'t�:,, .�t 71/
Subscribed and sworn to before me this
r- it „- I
7 1 7//1 Notary Public �, fZ.y,?Cti 5' ,/ i
Date: �'"// i T
My commission expires. i/ 17,�/'.�,}/
/_/C ?t„
r,
�, --� a/z�J,,
��L--• Director of Redevelopment ,
�`I4/6,G,3 7.3
REQUEST FOR PAYMENT DETAIL
Project: 11005/CARMEL P.73 FOUNTAIN Invoice: 3080 Draw:APP00001 Period Ending Date: 2/28/2011 Detail Page 2 of 2 Pages
Item ID Description Total Previously Work Presently Completed % Balance Retainage
Contract Completed Completed Stored And Stored Comp
To Balance
Amount Work This Materials To Date Finish
Period
01 FOUNTAIN BASIN&PIPING 62,350.00 15,587.50 15,587.50 25.00 46,762.50 1,558.75
02 FOUNTAIN EQUIP/IRON BOWL 80,950.00 38,046.50 38,046.50 47.00 42,903.50 ' 3,804.65
Totals 143,300.00 1 53,634.00 53,634.00 37.43 89,666.00 5,363.40 ,
AFFIDAVIT AND WAIVER OF LIEN
[ ] Final [X] Partial [X] Payment to Follow
State of Indiana -
County of Marion
T.M. Fansler , being duly sworn stages that he is the CEO of SMOCK FANSLER CORP.
having contracted with: Carmel Redevelopment Commission to furnish certain labor, materials,
and/or services as follows: Misc. Construction for a project known as: SFC#11-005 Carmel P. 73
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: (548,270.60)
Forty Eight Thousand Two Hundred Seventy Dollars and 60/100
[ ] receipt of which is hereby acknowledged;or
[X] the payment of which has been promised as thesole 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 /rl`'J -,....b x-4(41, - Title CEO
T.M. Fansler
WITNESS MY VIAND AND NOTARIAL SEAL,this le day of February ,2011.
/ / A
//1 tai :� ��� )./W�,
•
Melissa J. Bishop Notaiy1+public
My commission expires November 30,2016 Residing in Morgan County
Fountains
(Signature)
February 2011
Application 1
Amount to be paid by Carmel Theater Development $ 2,681;.70'.
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Parcel 73 Fountains APPLICATION NO Invoice#1 1 Distribution to:
Carmel Indiana 46032 Signature costs OWNER
ARCI-IITECT
PERIOD TO: 02/22/2011 X CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:Pedcor Design
Signature Construction Services LLC
720 3rd Avenue S.W. PROJECT NOS: '
Carmel, Indiana 46032
CONTRACT FOR: CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been
Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by
`` >' 0 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.
_ _ _ ."' \ 1
I. ORIGINAL CONTRACT SUM $ \ 143,300.00
2. Net change by Change Orders $ \43,300.00 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1 ±2) $ /
4. TOTAL COMPLETED&STORED TO $ ,681.70
By -, ' . Date: .Z-4' //
5. RETAINAGE: ' otnas E.Ko•ntz,President
a. 0 %of Completed Work $ 0 Subsc ibed and sw'm to before me this day of f( . _) ' /(
(Column D+E on G703) F"N LINDA BUCHANAN
b. %of Stored Material $ 'NOTARY. Hancock County
(Column F on G703) ,..sen ,., My Commission Expires
Total Retainage(Lines 5a+5b or '`"2'aa ENO' August 20,2011.
Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT'^'
6. TOTAL EARNED LESS RETAINAGE $ 2,681.70 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR • Architect's knowledge,information and belief the Work has progressed as indicated,
PAYMENT(Line 6 from prior Certificate) $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 2,681.70 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 140,618.30
(Line 3 less Line 6) AMOUNT CERTIFIED $ 2M) J
ci;\
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanati, i amount certified differs from the amount applied.Initial all figures on this
Total changes approved Application an, ontl e Cant' i lion Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT.
Total approved this Month By: Date: 2174/,f
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
contractor named nerein.issuance,payment and acceptance of payment are without
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702'APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION'AIA '01992 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.
Director of Redevelopmerr?/ �' C 7_,3
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 1
•
2/22/11
Parcel 73 Fountains
Carmel , Indiana
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed
NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost
General Requirements:
Site Supervision 71,650.00 0.00 0.00 0.00 0.00 0% 71,650.00 0.00
Construction Management Fee 71,650.00 0.00 2,681.70 0.00 2,681.70 4% 68,968.30 2,681.70
143,300.00 0.00 2,681.70 0.00 2,681.70 2% 140,618.30 2,681.70
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 73 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 two thousand
six hundred eighty-one dollars and seventy cents ($2,681.70) 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
omas E. oontz, President
ubscribed and sworn to before me this: '�%' '� -)�- //
Notary Public:
::FYP�•. LIN BHANAN
„�rAA Hancock DA UC
County
se. _; My Commission Expires
August 20,2011