HomeMy WebLinkAboutSignature Construction - $14,859.91 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.
Amount of Authorized Disbursement
Amount to be paid by Carmel Theater Development Company as per the
Fountains installment purchase contract
Pay application 4(Signature) May 2011 $ 5,329.81
Pay application 4(Smock Fansler) May 2011 $ 9,530.10
Total Authorized Disbursement $ 14,859.91
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 ank and Carmel Theater Development Company, LLC.
Dated: (to 2 3 1/ CITY OF CARMEL REDEVELOPMENT
COMMISSION
By:___Ce"---
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
(Signature)
February 2011
Application 1
Paid by Carmel Theater Development $ 2,681.70
March 2011
Application 2
Paid by Carmel Theater Development $ 2,084.93
April 2011
Application 3
Paid by Carmel Theater Development $ 1,635.37
May 2011
Application 4
Amount to be paid by Carmel Theater Development $ 5,329.81
APPLICATION AND CERTIFICATION FOR PAYMENT AlA DOCUMENT G702 PAGE ONE OF 2 PAGES2
TO OWNER CRC at City of Carmel PROJECT: Parcel 73 Fountains APPLICATION NO Invoice ti 4 I Distribution to:
Carmel Indiana 46032 Signature costs OWNER
ARCHITECT
PERIOD TO: 5/23/2011 X CONTRACTOR
FROM CONTRACTOR: VIA ARCI-IITECT: 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
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.
I. ORIGINAL CONTRACT SUM $ 14,330.00
2. Net change by Change Orders S 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1±2) 5 14,330.00 /
4. TOTAL COMPLETED&STORED TO S 11,731.81
By: ) 7 Date: , Z ,%
•
5. RETAINAGE: I homa�Y 'oontz, resisent /
a. 0%of Completed Work $ 0 S 'scribed an sworn to before me t s 07�r� day of _1
a. )U'1
(�11-nD +-EonG703)
.a..>�'• LINDA BUCHANAN
b. %of Stored Material $ p..•
(Column F on G703) Hancock County
NO .
total Ketamage(Lines 3a+30 or '1',,,,...sir My Commission Expires
Total in Column lofG703) $ 0.00 ARCHITECT'S CERTIFICATE FUR PAYMENT ki ~` '".- August 20,2011
6. TOTAL EARNED LESS RETAINAGE $ 11,731.81 In accordance with the Contract Documents,based on on-site observations and the data a
(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) $ 6,402.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 5,329.81 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 2,398.19
(Line 3 less Line 6) AMOUNT CERTIFIED $ 5r3Z9.k
CHANGE ORDER SUMMARY ADDI l IONS DEDUL I IONS ' (Attach explanation ife n .n it certified differs from the amount applied.Initial all figures on this
Total changes approved Application and onth: or inuation et drat are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT:
Total approved this Month By: Date: 5/3(/(i
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
L.ontractor namea nerem.issuance,payment aria acceptance on payment are wnnout
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.
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 4
5/23/11
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 7,165.00 0.00 5,329.81 0.00 5,329.81 74% 1,835.19 5,329.81
Construction Management Fee 7,165.00 6,402.00 0.00 0.00 6,402.00 89% 763.00 6,402.00
14,330.00 6,402.00 5,329.81 0.00 11,731.81 82% 2,598.19 11,731.81
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 five thousand three hundred
twenty-nine dollars and eight-one cents ($5,329.81) 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
/Thom . Koontz, President/
Subscribed and sworn to before me this: /flay a./-xii/
Notary Public: /9. ✓ �c1.�,��
LINDA BUCHANAN
• NOTARY. e Hancock County
• sEAL My Commission Expires
• EGf Mi:' August20,2011 ,
Fountains
(Smock Fansler)
February 2011
Application 1
Paid by Carmel Theater Development $ 48,270.60
March 2011
Application 2
Paid by Carmel Theater Development $ 37,528.65
April 2011
Application 3
Paid by Carmel Theater Development $ 29,436.75
May 2011
Application 4
Amount to be paid by Carmel Theater Development $ 9,530.10
L
0
AIA Type Document -
Application and Certification for Payment Z-If Page 1 of 2
CARMEL REDEVELOPMNT COMMISSION PROJECT:CARMEL P.73 FOUNTAIN APPLICATION NO: 4 DISTRIBUTION
TO(OWNER): 30 W.MAIN ST. TO:
CARMEL,IN 46032 CARMEL,IN 46032
30 W.MAIN ST. PERIOD 70:5!31/2011 OWNER
-
ARCHITECT
_CONTRACTOR
FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S
2910 W.Minnesota Street PROJECT NO:
Indianapolis,IN 46241
CONTRACT FOR: CONTRACT DATE:
The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and
CONTRACTOR'S APPLICATION FOR PAYMENT belief the work covered by this application for Payment has been completed in accordance with the
Application is made for Payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
r. , Ljt��` -
1.ORIGINAL CONTRACT SUM S 143,300.00 •
CONTRACTOR Smock Fansler Corporation
2.Net Change by Change Orders $ 0.00 2910 W.Minnesota Street Indianapolis,IN 46241 = --°-
:`I"f
3.CONTRACT SUM TO DATE(Line 1 +2) $ 143,300 00
f9 ?; - A, ii -
4.TOTAL COMPLETED AND STORED TO DATE S 138,629.00 By �` 2, / .., Date ff J
T.M.Fansler / CEO '
5.RETAINAGE: , �r'it,'r__... --\�,i'``a&
State of:IN �-�;�Ql�'.t�'��,_„
a. 10.00%of Completed Work $ 13,862.90 County of. MORGAN
L? Y 20
b 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this / Day of f:'':%
j%
Total retainage(Line 5a+5b) $ 13,862 90 Notary Public /` // ' . {° , ,, .f '
My Commission Expires: i ` :;// 2("J4
6.TOTAL EARNED LESS RETAINAGE $ 124,766.10
ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 less Line 5 Total)
7.LESS PREVIOUS CERTIFICATES 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
(Line 6 from prior Certificate) S 115,236 00 knowledge; information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE $ 9,530.10 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
AMOUNT CERTIFIED.
9.BALANCE TO FINISH,INCLUDING RETAINAGE
(Line 3 less Line 6) $ 18,533.90 AMOUNT CERTIFIED S 1 5 0. 10
(Attach explanation i ..---•at cerfifh d differs from the amount applied. Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and o re Conti .. . r heel that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT: , t1i�
previous months by Owner 0.00 0.00 By. ���_ -/�i Date:
0.00 0.00 This Certifi.ate is n-.t negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
Total approved this Month named herein. ante,Payment and acceptance of payment are wi hout prejudice to any
TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract. ?
NET CHANGES by Change Order 0.00 _L t).,� 6(3'(C(
,. # 5(d-S',, rY VVV
Director of Redevelopmen y/�of 73 CJ� ' '
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):CARMEL REDEVELOPMNT COMMISSION PROJECT:CARMEL P.73 FOUNTAIN APPLICATION NO:4 DISTRIBUTION
30 W.MAIN ST. 30 W.MAIN ST. TO:
CARMEL,IN 46032 CARMEL,IN 46032 PERIOD TO:5/31/2011 _OWNER
_ARCHITECT
_CONTRACTOR
FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S
2910 W.Minnesota Street PROJECT NO:
Indianapolis,IN 46241
CONTRACT FOR: CONTRACT DATE:
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1 FOUNTAIN BASIN&PIPING 62,350.00 59,232.50 2,494.00 0.00 61,726.50 99.00 623.50 6,172.65
2 FOUNTAIN EQUIP/IRON BOWL 80,950.00 68,807.50 8,095.00 0.00 76,902.50 95.00 4,047.50 7,690.25
REPORT TOTALS $143,300.00 $128,040.00 $10,589.00 $0.00 $138,629.00 96.74 $4,671.00 $13,862.90