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Home My WebLink AboutSignature Construction - $1,212.19 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 6(Signature) July 2011 $ 1,212.19 Total Authorized Disbursement $ 1,212.19 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 Regio/I1 s Bank and Carmel Theater Development Company, LLC. Dated: 8 /1r CITY OF CARMEL REDEVELOPMENT 111 COMMISSION By: �-- 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 Paid by Carmel Theater Development $ 5,329.81 June 2011 Application 5 Paid by Carmel Theater Development $ 763.00 July 2011 Application 6 Amount to be paid by Carmel Theater Development $ 1,212.19 .. - APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Parcel 73 Fountains APPLICATION NO Invoice u 6 I Distribution to: Carmel Indiana 46032 Signature costs OWNER ARCHITECT PERIOD TO: 7/21/2011 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 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 $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I ±2) $ 14,330.00 / 4. TOTAL COMPLETED&STORED TO $ 13,707.00 By: - 1 t Date: 7 z / 5. RETAINAGE: Thomas oontz,President ,j a. 0 %of Completed Work $ 0 Su scribed and von to before me thi 'a" day of j Gt/y,t 3 O!/ (Column D+E on G703) .•;a Pia• LINDA BUCHANAN b. %of Stored Material $ :NOTARY , (Column I'on G703) "°T^R�� : Hancock County ( ) N. sex .. My Commission Expires Total Retainage(Lines 5a+5b or '';': :,,e'' August 20,2011 Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMEI "'""' 6. TOTAL EARNED LESS RETAINAGE $ 13,707.00 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) $ 12,494.81 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 1,212.19 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 623.00 (Line 3 less Line 6) AMOUNT CERTIFIED $ 1,242_15 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation • nount certified differs from the amount applied. Initial all figures on this Total changes approved Application an onthe ontin Lion Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT Total approved this Month By: 002‘.....- Date: 71Z451I( p TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor named herein.issuance,payment and acceptance of payment are wimout 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 # 6 7/21/11 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 5,329.81 1,212.19 0.00 6,542.00 91% 623.00 6,542.00 Construction Management Fee 7,165.00 7,165.00 0.00 0.00 7,165.00 100% 0.00 7,165.00 14,330.00 12,494.81 1,212.19 0.00 13,707.00 96% 623.00 13,707.00 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 one thousand two hundred twelve dollars and nineteen cents ($1,212.19) 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 - Th'.mas E!%oontz, President Subscribed and sworn to before me this:12 J u�Y r.)o// Notary Public: .,,,,, LINDA BUCHANAN Hancock County s. s My Commission Expires �'oF;;0 August 20,2011