HomeMy WebLinkAboutHagerman Construction - East Retaining Wall-Century 21 Project - $2,500Exhibit D
Disbursement Instructions
Mercantile 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: tine 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
Hagerman Construction Appl. #1
$2,375.00
Hagerman Construction Appl. #2 (Retainage)
$ 125.00
Total Authorized Disbursement
$2.500.00
All terms used in these Disbursement Instructions without definition shall have the meanings
ascribed thereto in that certain Loan Agreement (PAC Equipment), dated, as of August 31, 2009,
by and between Lender and Village Financial, LLC.
Dated:
1.7tA)
/1
CITY OF CARMEL REDEVELOPMENT
COMMISSION
By
Printed Lei 1-. CLa-f
Title Par' , /,1,t741P'"
REQUEST FOR PAYMENT
From: Hagerman Construction Corporation
P O Box 10690
Fort Wayne, IN 46853 -0690
Contract For: P112 East retaining Wall Centu
To: SIGNATURE CONSTRUCTION
720 3rd Ave. S.W.
CARMEL, IN 46032
Invoice: 85559
Draw: APP A001
Invoice date: 11/29/2012
Period ending date: 12/30/2012
Request for payment:
Original contract amount
Approved changes
Revised contract amount
Contract completed to date
Add -ons to date.
Taxes to date
Less retainage
Total completed Tess retainage
Less previous requests
Current request for payment
Current billing
Current additional charges
Current tax
Less current retainage
Current amount due
$2,500.00
$0.00
$0.00
$0.00
$125.00
$0.00
$0.00
$0.00
$125.00
Remaining contract to bill $125.00
$2,500.00
$2,500.00
$2,375.00
$2,375.00
$2,500.00
$2,375.00
Project: 12- 3129 -2
P112 East retaining Wall Centu
Contract date:
Architect:
Scope:
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Changes approved in previous
months by Owner
Total approved this Month
TOTALS
NET CHANGES by Change Order
1 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 SIGNATURE CONSTRUCTION relating to the above referenced project. I also certify that the
contractor has paid all amounts previously billed and paid by the owner. )
CONTRACTOR: Hagerman Construction Corr
1
%1
By:
Date:
vitrup
/),/%47h
State Of
County Of
Subscribed and sworn to before me this __ day of / ,: v.
d///,�,
Notary Public ✓.-«
My commission expires:
r, A rVU\
:torn,:, •.: Merlon County
5.: ; ;6 { My Commission E giros
^ . ril 23, 2014
REQUEST" FOR PAYMENT DETAIL
Project: 12- 3129 -2 / P112 East retaining Wall Ceni Invoice :85559
Draw: APP A001
Period Ending Date: 12/30/2012 Detail Page 2 of 2 Pages
Stem
ID
Description
Total
Contract
Amount
Previously
Completed
Work
Work
Completed
This
Period
Completed
To Date
%
Comp
Balance to
Finish
Retainage
Balance
001 P112 East Retaining Wall
2,500.00
2,500.00
2,500.00
100.00
0.00
Totals
2,500.00
2,500.00
2,500.00
00 .00
0.00
125.00
Exhibit 1
CONTRACTOR'S AFFIDAVIT, PARTIAL LIEN WAIVER
AND PARTIAL RELEASE
STATE OF Indiana
COUNTY OF Hamilton
The undersigned individual, Bruce A. Molter, first being duly sworn, deposes and says that he is
the Executive Vice President for Hagerman Construction Corp. ( "Contractor ") and being duly
authorized by the said Contractor to do so, hereby certifies and represents as follows:
(1)
The undersigned Contractor has contracted (the "Contract ") with Signature
Construction, LLC ( "Construction Manager ") to furnish labor, materials, equipment
and services, or some of same, for the PI 12 EAST RETAINING WALL- CENTURY
21 ( "Project ") which is located in Carmel, IN.
(2) All Labor, materials, equipment and services provided or purchased for the Project
for and during the month, or months, preceding the month for which the current
Application for Payment is made have been paid in full.
(3)
Upon receipt of $2,375.00 for Contractor's Application Payment No. Al for period
end 12/30/12 , Contractor waives and releases any and all claims against the Owner
therefore and further waives and releases any and all liens, claims of liens or other
claims it has against the Project and the real property upon which the improvements
are being made, all in connection with, and to the full extent of, the work performed
by Contractor on the Project through the date to which said Application for Payment
applies, excepting only those claims and liens, if any, that the Contractor may have
for any retained amounts.
(4) Contractor agrees to indemnify and hold harmless the Owner from all claims, liens,
and claims of liens by Contractor or anyone claiming by, through or under the
Contractor for labor, materials, equipment and services provided through the date
described in Paragraph (3) above.
Sworn to and subscribed before me
This-21 day of ,Vd, , 2012
athr Y n
Notary Public in and for said County and State
My commission expires: 4/23/14
My County of Residence: Marion
KATHRYN C. ARVIN
Marion County
My Commission Expires
April 23, 2014
Contractor's Name:
Hagerman Construction Corp,
By:
Bruce A. Molter
Printed name
Executive Vice President
(Title)
REQUEST FOR PAYMENT
From:
Hagerman Construction Corporation
P 0 Box 10690
Fort Wayne, IN 46853 -0690
Contract For: P112 East retaining Wail Centu
To: SIGNATURE CONSTRUCTION
720 3rd Ave. S.W.
CARMEL, IN 46032
Invoice: 85560
Draw: APP A002
Invoice date: 11/29/2012
Period ending date: 12/30/2012
Request for payment:
Original contract amount
Approved changes
Revised contract amount
$2,500.00
$0.00
Contract completed to date
Add -ons to date $0.00
Taxes to date $0.00
Less retainage $0.00
Total completed less retainage
Less previous requests $2,375.00
Current request for payment
Current billing
Current additional charges $0.00
Current tax $0.00
Less current retainage - $125.00
Current amount due
Remaining contract to bill $0.00
$2,500.00
$2,500.00
$2,500.00
$125.00
$0.00
$125.00
Project: 12- 3129 -2
P112 East retainina Wall Centu
Contract date:
Architect:
Scope:
ORDER SUMMARY
ADDITIONS
DEDUCTIONS
_CHANGE
Changes approved in previous
months by Owner
Total approved this Month
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 (arid all authorized changes thereof) between the undersigned and the SIGNATURE CONSTRUCTION relating to the above referenced project. I also certify that the
contractor has paid all amounts previously billed and paid by the owner.
CONTRACTOR: Hagerman Construction Corf
By: ( t-l)+
U
Date: f / ///
State Of
County Of
Subscribed and sworn to before me this � day of L/' , , u / 2-
Notary Public
My commission expires: t.
RAI C. ARVIN
t Marion County
My Commission Expires
X123, 2014
REQUEST FOR PAYMENT DETAIL
Project: 12- 3129 -2 / P112 East retaining Wall Cenl Invoice: 85555
Draw: APPA002
Period Ending Date: 12/30/2012 Detail Page 2 of 2 Pages
Item
ID
Description
Total
Contract
Amount
Previously
Completed
Work
Work
Completed
This
Period
Completed
To Date
�°
Comp
Balance to
Finish
Retainage
Balance
P112 East Retaining Wall
2,500.00
2,500.00
2,500.00
100.00
0.00
Totals
2,500.00
2,500.00
I
2,500.00
00.00
0.00
Exhibit 1
CONTRACTOR'S AFFIDAVIT, FINAL LIEN WAIVER
AND FINAL RELEASE
STATE OF bndiana
COUNTY OF Hamilton
The undersigned individual, Bruce A. Molter, first being duly sworn, deposes and says that he is
the Executive Vice President for Hagerman Construction Corp. ( "Contractor ") and being duly
authorized by the said Contractor to do so, hereby certifies and represents as follows:
(1)
The undersigned Contractor has contracted (the "Contract ") with Signature
Construction, LLC ( "Construction Manager ") to furnish labor, materials, equipment
and services, or some of same, for the P112 EAST RETAINING WALL - CENTURY
21 ( "Project") which is located in Carmel, IN.
(2) All Labor, materials, equipment and services provided or purchased for the Project
for and during the month, or months, preceding the month for which the current
Application for Payment is made have been paid in full.
Upon receipt of 5125.00 for Contractor's Application Payment No. A2 for period
end 12/30/12 , Contractor waives and releases any and all claims against the Owner
therefore and further waives and releases any and all liens, claims of liens or other
claims it has against the Project and the real property upon which the improvements
are being made, all in connection with, and to the full extent of the work performed
by Contractor on the Project through the date to which said Application for Payment
applies, excepting only those claims and liens, if any, that the Contractor may have
for any retained amounts.
(4) Contractor agrees to indemnify and hold harmless the Owner from all claims, liens,
and claims of liens by Contractor or anyone claiming by, through or under the
Contractor for labor, materials, equipment and services provided through the date
described in Paragraph (3) above.
(3)
Sworn to and subscribed before me
This day of AM/ .. , 2012
ffiti
Kathryn Arvin
Notary Public in and for said County and State
My commission expires: 4/23/14
My County of Residence: Marion
KATHRYN C. ARVIN
Marion County
My Commission Expires
Ap»I 23.2014
Contractor's Name:
Hagerman Construction Corp.
By:
Bruce A. Molter
Printed name
Executive Vice President
(Title)
December 14, 2012
Hagerman Construction Corporation (Masonry)
10315 Allisonville Road
Fishers, IN 46038
RE: PI12 East Retaining Wall
HCC Project No.: 123140 -A
Hagerman Construction Corporation Warranty
To Whom It May Concern,
Hagerman Construction Corporation does hereby guarantee all work performed under the scope of our Contract for
a period of one [1] year beginning at the Substantial Completion date.
For claims call:
Greg Delagrange
Hagerman Construction Corporation
10315 Allisonville Road
Fishers, IN 46038 -2017
Phone: 317 -577 -6836
If you have any questions regarding this warranty, please feel free to contact our office.
Sincerely,
HAGERMAN CONSTRUCTION CORPORATION
Joel Tresslar
Project Manager
Hagerman Construction Corporation 111315 Aliisrniitte rd. Fisher,, fN 46038 -2017 ph i317i 577 -68:6 ix: j317! 577 -6841 w.•r;+.r chagermangroup.corn