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Gibraltar - $25,361.30
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 Motor Court Improvements installment purchase contract Application 6(Gibraltar) June 2011 $ 25,361.30 Total Authorized Disbursement $ 25,361.30 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 Bank and Carmel Theater Development Company, LLC. Dated: 4A-42 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. A P5 Motor Court (Gibraltar) January 2011 Application 1 Paid by Carmel Theater Development $ 47,936.70 February 2011 Application 2 Paid by Carmel Theater Development $ 19,872.00 March 2011 Application 3 Paid by Carmel Theater Development $ 54,382.50 April 2011 Application 4 Paid by Carmel Theater Development $ 93,636.00 May 2011 Application 5 Paid by Carmel Theater Development $ 12,424.50 June 2011 Application 6 Amount to be paid by Carmel Theater Development $ 25,361.30 ...... ! AI Document G702ICMaTM ® 1992 Application and Certificate for Payment Construction Manager-Adviser Epdiittii�on�Tl N TO OWNER: Camlel Theater Development CompareROJECT: Plaza Parcel 5;Phase 1,Carmel City CentBY-Mlf1dY PIN NO: 6 Distribution to: Carmel,IN 46032 PERIOD TO: 6/30/11 OWNER ❑ a CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGE ., 4 CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 7 , 4/13/10 2932 N.Webster Ave. 0° c PROJECT NOS: / / CONTRACTOR ❑ Indianapolis, IN 46219 !:�') VIA ARCHITECT N\ FIELD ❑ Pedcor DesignGrou"i,,t.LC ,. CONTRACT FOR: Waterproofing and Paving Components - ' ' al •- ❑ r CONTRACTOR'S APPLICATION FOR PAYMENT Ville undersigned Contractor certit es that to the best of the Contractor's knowledge, information and Application is made for payment.as shown below,in connection with the Contract. belief the Work covered by chi.,, • splitation for Payment has been completed in accordance with the . Contract Documents, that all a ° e is have been paid by the Contractor for Work for which previous Continuation Sheet, AIA Document G703,is attached 25361300 Certificates for Payment we g. ,s•u:d and payments received from the Owner, and that current , . 1.ORIGINAL CONTRACT SUM $ payment shown herein is no 7i -. 2. Net change by Change Orders 0.00 Gibraltar !�•,st ction Corp $ CONTRACTOR: 153;513.00 , �-���r/ 3.CONTRACT SUM TO DATE(Line 1 ±2) $ By: ,/ Date: 253,813.00 /4,2� 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ State of: 1(. .,4,4„,� ' - 5.RETAINAGE: County of %. I ���` "�E,^ BRIAN R. MCBRIDE // z Res. of Hancock County a. %of Completed Work 0.00 Subscribed and swo� • ee • t * (Column D+Eon G703) $ me this. i y of lAii -2.4.0/1 _ My Comm, Exp, 11-29-2017 b. o of Stored Material Notary Public: / /D! N Commission # 611862 (Column F on G703) $ My Commission expires: ,./-9 '/" Total Retainage(Lines 5a+5b or Total in Column I of G703). $. CERTIFICATE FOR PAYMENT 253,613.00 In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ this application, the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 228,251.70 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 25,361..50 8.CURRENT PAYMENT DUE _$ AMOUNT CERTIFIED $ 27`'i , C 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this 0.00 Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ CONSTRUCTION MAN E' By: Date: 36 0/A- CHANGE ORDER SUMMARY ADDTONS DEDUCTIONS ARCHITECT: -.ign Group,LLC Total changes approved in previous months by Owner $ $ y �� Date: $ $ This Certificate is n• ne otiabl• " e AMOUNT CERIftt teD is payable_ B 3 Total approved this Month nl to the Contractor TOTALS $ $ named herein. s':see, say •-nt .•d . -It. ce of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Co acto •er Chi. •e act. 3 Zq CAUTION:You should sign an original AlA contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702ICMaTu-1992.' Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and international.Treaties. CONTINUATION SHEET Page 2 of 2 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification, is APPLICATION NO. : 6 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where APPLICATION DATE: 6/30/2011 variable retainage for line items may apply. PERIOD TO: 6/30/2011 ARCHITECT'S PROJECT NO. : A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM FROM PREVIOUS PRESENTLY COMPLETED AND % BALANCE TO RETAINAGE NO. DESCRIPTION OF WORK SCHEDULED VALUE FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) (C-G) RATE) (D+E) DORE) (D+E+F) 1 Supervision $1,000.00 $1,000.00 $1,000.00 100% - 2 Trench Drain Material $7,500.00 $7,500.00 $7,500.00 100% - 3 Trench Drain Labor $1,500.00 $1,500.00 $1,500.00 100% - 4 Concrete Topping Slabs&Curbs Mt'l $60,000.00 $60,000.00 $60,000.00 100% - 5 Concrete Topping Slabs&Curbs Labor $69,213.00 $69,213.00 $69,213.00 100% - 6 Waterproofing & Expansion Joints $107,000.00 $107,000.00 $107,000.00 100% - 7 Plumbing $7,400.00 $7,400.00 $7,400.00 100% - $253,613.00 $253,613.00 $0.00 $0.00 $253,613.00 100% $0.00 $0.00 ISA Form#1-402 AFFIDAVIT AND WAIVER OF LIEN ® FINAL ❑ PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and/or labor for a project known as Carmel City Cntr-P111 -Waterproofing and Paving Components-Motor Court and owned by Carmel Theater Development Company. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the Owner the sum of Dollars ($ ) ❑ 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 Twenty Five Thousand Three Hundred Sixty One and 30/100------- Dollars ($25,361.30) ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THERFORE, 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 ccount of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditions -xpr=ssed herein, if any; and further certifies that no otherparty has any claim or right to a lien on account of any work r rfor ed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By iii Title President WITNESS MY HAND AND NOTORIAL SEA i ( t d of June, 2011. (Notary Public) 6s �7( BRIAN R. MCBRIDE 2 Res. of Hancock County C 1979 !l1 DIANA SUBCONTRACTORS ASSOCIAT*ON tNCOAVORATED Y vr•su9nar«t.dQ Reprodvctwn�o>~FhitAtl 01 AN M Comm. �, 11-29-2017 ��° '0t9° Commission #611862