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Home My WebLink AboutSignature Construction, Smock Fansler - $14,953 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(Smock) August 2011 $ 14,330.00 Application 7(Signature) August 2011 $ 623.00 Total Authorized Disbursement $ 14,953.00 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 B k and Carmel Theater Development Company, LLC. Dated: // CITY OF CARMEL REDEVELOPMENT 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 (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 Paid by Carmel Theater Development $ 9,530.10 June 2011 Application 5 Paid by Carmel Theater Development $ 4,203.90 August 2011 Application 6 Amount to be paid by Carmel Theater Development $ 14,330.00 2! AIA Type Document �3� Application and Certification for Payment Page 1 of 2 TO(OWNER):CARMEL REDEVELOPMNT COMMISSION PROJECT:CARMEL P. 73 FOUNTAIN APPLICATION NO: 6 `•-�rt DISTRIBUTION 30 W.MAIN ST. 30 W.MAIN ST. /' ` TO: CARMEL, IN 46032 CARMEL, IN 46032 PERIOD T0:8/32011 ryAvG O -_OWNE er ®_CONTRACTOR FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S '77 2910 W. Minnesota Street PROJECT NO: Indianapolis, IN 46241 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT 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 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. current payment for Payment were herein is now and payments received from the owner`and,ii[hat PUB /�O 1.ORIGINAL CONTRACT SUM $ 143,300.00 ��'<i•-`.-• �/C CONTRACTOR: Smock Fansler Corporation Z 2.Net Change by Change Orders $ 0.00 2910 W. Minnesota Street Indianapolis, IN 46241 -•� 3.CONTRACT SUM TO DATE(Line 1 +2) $ 143,300.00 = / ��J 4.TOTAL COMPLETED AND STORED TO DATE $ 143,300.00 By: ` r , C Date: t.7/ •� T.M. Fansler / CEO 60 �Q�� 5.RETAINAGE:0.00%of Completed Work $ 0.00 State of:IN ///��iiii�/��s/TAPE OF\O"��\\\ County of: MORGAN nurmilimn„\\ b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this 5' Day of q s 20 �r Total retainage(Line 5a+5b) $ 0.00 Notary Public: y� v My Commission Expires: // - 3/ 6.TOTAL EARNED LESS RETAINAGE $ 143,300.00 ( vv (Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAYMENT 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations and the data com- (Line 6 from prior Certificate) $ 128,970.00 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 8.CURRENT PAYMENT DUE $ 14,330.00 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) $ 0.00 AMOUNT CERTIFIED $14.15jjQ-C'-^t—' - (Attach expl.. atio if amount certified differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Applicati. and o the •on,nua . eet that are changed to conform to the amount certified.) Total changes approved in ARCHIT CT: previous months by Owner , 0.00 0.00 By: i ., Date: o° / Ill Total approved this Month 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 without prejudice to any TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 0.00 t,/}S/I/ Cm // AIA Type Document Application and Certification for Payment Page 2 of 2 TO(OWNER):CARMEL REDEVELOPMNT COMMISSION PROJECT:CARMEL P. 73 FOUNTAIN APPLICATION NO: 6 DISTRIBUTION 30 W. MAIN ST. 30 W. MAIN ST. TO: CARMEL, IN 46032 CARMEL, IN 46032 PERIOD TO:8/31/2011 _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 ado BALANCE RETAINAGE 1 FOUNTAIN BASIN&PIPING 62,350.00 62,350.00 0.00 0.00 62,350.00 100.00 0.00 0.00 2 FOUNTAIN EQUIP/IRON BOWL 80,950.00 80,950.00 0.00 0.00 80,950.00 100.00 0.00 0.00 REPORT TOTALS $143,300.00 $143,300.00 $0.00 $0.00 $143,300.00 100.00 $0.00 $0.00 Y 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 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: ($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 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($14,330.00) Fourteen Thousand Three Hundred Thirty Dollars and No/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 receiptof 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.s SMOCK FANSLER CORP. By 7 Title CEO T.M. Fansler WITNESS MY HAND AND NOTARIAL SEAL, this 5th day of August ,2011. ��o��°��p,RYPU ,44 . • Melissa J. Bishop Public _* P Nota Pu = SEAS, .' _ My commission expires November 30, 2016 Residing in Morgan County %STy' • OF IiNIp 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 Paid by Carmel Theater Development $ 1,212.19 August 2011 Application 7 Amount to be paid by Carmel Theater Development $ 623.00 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Parcel 73 Fountains APPLICATION NO Invoice N 7 1 Distribution to: Carmel Indiana 46032 Signature costs OWNER ARCHITECT PERIOD TO: 8/25/2011 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. 1. 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 $ 14,330.00 j By: -. / Date: 8/ 7/// / 5. RETAINAGE: 'homas E. ..•ntz,President a. 0 %of Completed Work $ 0 Subs.,ibed and s .‘m to before me this day ofQq , Jo LINDA C�.BUCHANAN Column D+E on G703) / 5 ��YP°s;_ b. ( %of Stored Material $ 7 ',o.nav Hancock County (Column F on e(Lin) a.N 9 a., My Commission Expires Total Retainage(Lines 5a+Sb orp�„ August 20 2w19 Total in Column 1 of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 14,330.00 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) $ 13,707.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 623.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED $ 44,5.E CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expla .lion if amount certified differs from the amount applied.Initial all figures on this Total changes approved Applicatio and ont • Co nua.on Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITCCT: e Total approved this Month By: Date: O/3r li 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 or 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. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 7 8/25/11 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 6,542.00 623.00 0.00 7,165.00 100% 0.00 7,165.00 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 13,707.00 623.00 0.00 14,330.00 100% 0.00 14,330.00 T. 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 six hundred twenty-three dollars ($623.00) 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 - t f Thom E. Koontz, President Subscribed and sworn to before me this .3t/ a oil Notary Public: � � .f�,�.•� =a.:�'R'y LINDA G.BUCHANAN .NOTARY Hancock County My Commission Expires •'lEGF>:�*, Au ust 2O,2019