HomeMy WebLinkAboutSignature, Smock Fansler - $58,314.42 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 4(Smock Fansler) July 2011 $ 47,414.25
Application 3(Signature) July 2011 $ 10,900.17
Total Authorized Disbursement $ 58,314.42
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: 8/0/// CITY OF CARMEL REDEVELOPMENT
COMMISSION
By. NIV''
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.
P5 Motor Court
(Smock Fansler)
April 2011
Application 1
Paid by Carmel Theater Development $ 55,530.00
May 2011
Application 2
Paid by Carmel Theater Development $ 36,052.20
June 2011
Application 3
Paid by Carmel Theater Development $ 93,100.50
July 2011
Application 4
Amount to be paid by Carmel Theater Development $ 47,414.25
AlA Type Document
Application and Certification for Payment Page 1 of 2 •
TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT:MOTOR COURT PAVING APPLICATION NO: 4 DISTRIBUTION
30 W.MAIN ST.
CARMEL,IN 46032 PERIOD TO:7/31/2011 TO:
OWNER
-
ARCHITECT
_CONTRACTOR
FROM(CONTRACTOR): Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S
2910 VV.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. Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM $ 268,590.00
2.Net Change by Change Orders $ 0.00 CONTRACTOR: Smock Fansler Corporation
2910 W.Minnesota Street Indianapolis,IN 46241 /
3.CONTRACT SUM TO DATE (Line 1 +2) $ 268,590.00 ,,, /
4.TOTAL COMPLETED AND STORED TO DATE $ 257,888.50 BY: ,.� ..�°jrf fs Date: t
T.M.FANSLER,JR. / CEO
5.RETAINAGE:
a. 10.00%of Completed Work $ 25,791.55 State of:IN
County of: MARION ',
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this '2 Q-1 Day of .,J CI L 1 f 20 1
t•
Total retainage(Line 5a+5b) $ 25.791 55 Notary Public: J)t l C_ l'f i., 6,r t.t.D i^ (-1 t,
My Commission Expires: 1 f_ f 5_1
6.TOTAL EARNED LESS RETAINAGE $ 232.096.95
(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 oUUserrations and lha data com-
(Line 6 from prior Certificate) $ 184,682.70 prising the above application, the Architect certifies to own,-.a-that to the best of the Architect's
knowledge,information and belief the Work has progressed as ir:,dicateU?'-he;quality of the work
8.CURRENT PAYMENT DUE $ 47,414.25 is in accordance with the Contract Documents, and the Contractor is ecli..!ed to payrfsait of the 60 AMOUNT CERTIFIED.
9.BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) $ 36,493.05 AMOUNT CERTIFIED $ (2c------
(Attach explanation if amount codified differs from the amount applied. Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on.t. - ontfnu for Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT: ...411 _
previous months by Owner 0.00 0.00 By. /J Date: 2g 1 \\
) r
Total approved this Month 0.00 0.00 This Certificate is no negotiable. The AMOUNT CERTIFIED is payable on to tfre Contractor
named herein. I - ante,Payment and acceptance of payment are wit : •rejudic an
TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 0.00
C rn: -�� --) LS l I 1
AIA Type Document '
Application and Certification for Payment Page 2 of 2 •
TO(OWNER):CARMEL REDEVELOPMENT COMM. PROJECT:MOTOR COURT PAVING" . NO: 4 DISTRIBUTION
30 W.MAIN ST. TO:
CARMEL,IN 46032 PERIOD TO:7/31/2011 _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 o BALANCE RETAINAGE
1 MOBILIZATION/DEMOBILIZATION 13,200.00 9,900.00 2,640.00 0.00 12,540.00 95.00 660.00 1,254.00
2 ASPHALT BASE 55,100.00 55,100.00 0.00 0.00 55,100.00 100.00 0.00 5,510.00
3 UNIT PAVERS 200,290.00 140,203.00 50,045.50 0.00 190,248.50 94.99 10,041.50 19,027.55
REPORT TOTALS $268,590.00 $205,203.00 $52,685.50 $0.00 $257,888.50 96.02 $10,701.50 $25,791.55
•
•
AFFIDAVIT AND WAIVER OF LIEN
[ ] Final [X] 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#.10-140 Cannel City Ctr. Motor
Ct. & Fountains located at Indianapolis, IN and does hereby state on behalf of the aforementioned
contractor:
(PARTIAL WAIVER) that there is clue from the owner the sum of: (547,414.25)
Forty Seven Thousand Four Hundred Fourteen Dollars and 25/100
[ ] receipt of which is hereby acknowledged; or
[X] 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(S0.00)
[ ] receipt of which is hereby acknowledged;or
[ J the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of
Lien which shall become effective upon receipt of 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.
SMOCK FANSLER CORP. y •,./e20"20' , i6 . title CEO...
T.'M. Fansler
WITNESS MY I-IAND AND NOTARIAL SEAL, this 21'x' day of July ,2011.
Glenda C{_Hill Notary Public
My commission expires_November 15. 2014 Residing in Marion County
P5 Motor Court
(Signature Construction - Smock)
May 2011
Application 1
Paid by Carmel Theater Development $ 5,087.90
June 2011
Application 2
Paid by Carmel Theater Development $ 7,700.92
July 2011
Application 3
Amount to be paid by Carmel Theater Development $ 10,900.17
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Motor Court APPLICATION NO Invoice#7-Smock 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 Contractors 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 $ 26,859.00
2. Net change by Change Orders $ 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1±2) $ 26,859.00
4. TOTAL COMPLETED&STORED TO $ 23,688.99
By: j Date: 7/Z-5--11/
5. RETAINAGE: Thomas E. Yoontz,President
a. 0 %of Completed Work $ 0 Su scribed and •vom to before me this a& day of 7.44,).00
(Column D+F on G703) ,pii�ay4. LINDA BUCHANAN
b. %of Stored Material $ s .n-TARV = Hancock County
(Column P on G703) N•,SEAL My Commission Expires
Total Retainage(Lines 5a+5b or 'EOFj"°�' August 20,2011
Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ 23,688.99 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) $ 12,788.82 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 10,900.17 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RIB TAINAGE $ 3,170.02
(Line 3 less Line 6) AMOUNT CERTIFIED $ In6\C \7
CI-lANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount ertified differs the amount applied.Initial all figures on this
Total changes approved Application and• 1e Con • ion Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT: /1I(X/
Total approved this Month By: \ Date: 2 ..../
IN l(/
TOTALS $0.00 $0.00 This Certificate is nit n otiable. The AMOUNT CERTIFIED is payable only to he
Contractor med I rein.Issuance,payment and acceptance of payment are wttho t
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 Li ee.
/area_ 7/Z0
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 7 - Smock
7/21/11
Motor Court - Smock
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 13,429.50 2,528.67 8,265.89 0.00 10,794.56 80% 2,634.94 10,794.56
Construction Management Fee 13,429.50 10,260.15 2,634.28 0.00 12,894.43 96% 535.07 12,894.43
26,859.00 12,788.82 10,900.17 0.00 23,688.99 88% 3,170.02 23,688.99
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
Motor Court, 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 ten thousand
nine hundred and seventeen cents ($10,900.17) 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 s E. Ko tz, President
Subscribed and sworn to before me this:; " ' v L14 dad
Notary Public�� y(i ��
�aY Pie.., LINDA BUCHANAN
'HOrnav' `. Hancock County
SEAL 4! My Commission Expires
'a� .'•` August 20,2011