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HomeMy WebLinkAboutSignature - $571.05 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(Signature) June 2011 $ 571.05 Total Authorized Disbursement $ 571.05 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: /!.,/�7/j 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. P5 Motor Court (Signature Construction - Gibraltar) January 2011 Application 1 Paid by Carmel Theater Development $ 2,663.15 February 2011 Application 2 Paid by Carmel Theater Development $ 5,414.43 March 2011 Application 3 Paid by Carmel Theater Development $ 6,824.47 April 2011 Application 4 Paid by Carmel Theater Development $ 5,892.25 May 2011 Application 5 Paid by Carmel Theater Development $ 9,888.20 April 2011 Application 4 Reimbursement to Carmel Theater Development $ (5,892.25) June 2011 Application 6 Amount to be paid by Carmel Theater Development $ 571.05 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Motor Court APPLICATION NO Invoice#6-Gibraltor I Distribution to: Carmel Indiana 46032 Signature costs OWNER iARCHITECT PERIOD TO: 6/23/201 I 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 0703,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 $ 25,361.30 2. Net change by Change Orders S 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1±2) 5 25,361.30 4. TOTAL COMPLETED&STORED TO $ 25,361.30 13 .A Date: 6/Z5/// 5. RETAINAGE: ton VKoontz,President I ( a. 0%orCompleted Work $ 0 .ubscribed a ,sworn to before me this 093 day of(i ,3.o C/ ( 1.min D+E on 0703) b. %of Stored Material 5 %o' LINDA BUCHANAN ('lumn F on G703) _NOT ' Hancock County I otal ketainage(Lines 5a-+-)D or .r. $Ed i.- My Commission Expires Total in Column I of G703) S 0.00 ARCHITECT'S GERTIFIGATE FUR PAYMENT ;" .�(,j.;?.' u�guT20,2011 6. TOTAL EARNED LESS RETAINAGE $ 25,361.30 In accordance with the Contract Documents,based on on-site observations and the' (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CER"TIFICA"TES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) 5 24,790.25 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE S 571.05 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE S 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED $ 511 ,0') LI-IANUE ORDER SUMMARY AUDI I IONS DEDUL I IONS (Attach explanation i/amount certified di/Jere from the amount applied.Initial all figures on this I otal changes approved Application and ant • entinuation Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT: Total approved this Month By: r dili \ Date: 4 Z- 11 `' TOTALS $0.00 $0.00 This Cern cate is n I new ia.le. The AMOUNT CERTIFIED is payable only to th contractor 'meu crew.issuance,payment ano acceptance or payment are wmou 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'©1992 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. (ti7LL frofft SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 6 - Gibraltor 6/23/11 Motor Court - Gibraltor 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 12,680.65 12,109.60 571.05 0.00 12,680.65 100% 0.00 12,680.65 Construction Management Fee 12,680.65 12,680.65 0.00 0.00 12,680.65 100% 0.00 12,680.65 25,361.30 24,790.25 571.05 0.00 25,361.30 100% 0.00 25,361.30 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 five hundred seventy-one dollars and five cents ($571.05) 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 //Thomas E'. ontz, President Subscribed and sworn to before me this: (fax€ a 3( )0// Notary Public: "<_A/,e1 ;.a aG',•. LINDA BUCHANAN ,,.''NOTARY`. Hancock County ..SEAL My Commission Expires .' ;N�:'•' August 20,2011