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Home My WebLink AboutHagerman Construction - East Retaining Wall Century 21 Project - $34,000Exhibit 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: 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 Hagerman Construction Appl. #1 $32,300.00 Hagerman Construction Appl. #2 (Retainage) $ 1,700.00 Total Authorized Disbursement $34.000.00: All terms used in these Disbursement Instructions without definition shall have the meanings ascnbed thereto in that certain Loan Agreement (PAC Sound Equipment), dated , as of August 31, 2009, by and between Lender and Village Financial, LLC. Dated: CITY OF CARMEL REDEVELOPMENT COMMISSION By Printed L i-f S. DLO-S' Title ��6c. p //J vC t 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: 85552 Draw: APP00001 Invoice date: 11/28/2012 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 less retainage Less previous requests Current request for payment Current billing Current additional charges Current tax Less current retainage Current amount due Remaining contract to bill $34,000.00 $0.00 $0.00 $0.00 $1,700.00 $0.00 $0.00 $0.00 $1,700.00 $1,700.00 $34,000.00 $34,000.00 $32,300.00 $32,300,00 $34,000.00 $32,300.00 Project: 12- 3129 -1 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 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 (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 CorF By: Date: State Of °,fie 4444- Subscribed and sworn to before me this A r Notary Public .14/4- My commission expires: • Li,/ County Of °°'°' rr-e- day day of 7%f< 26, t, z- A Ott t -323c) KATHRYN C. ARVIN Marion County My Commission Expirov April 23, 2014 REQUEST FOR PAYMENT DETAIL Project: 12- 3129 -1 / P112 East Retaining Wall -Cer invoice: 85552 Draw: APP00001 Period Ending Date: 12/3012012 Detail Page 2 of 2 Pages Item ID Description Total Contract Amount Previously Completed Work Work Completed This Period Completed To Date a /o Comp Balance to Finish Retainage Balance 001 Pavers, concrete, caulking etc 34,000.00 34, 000.00 34,000.00 100.00 0.00 1,700. Totals 34,000.00 34,000.00 34,000.00 00,00 0.00 1,700.00 Exhibit 1 CONTRACTOR'S AFFIDAVIT, PARTIAL LIEN WAIVER AND PARTIAL RELEASE STATE OF Indiana COUNTY OF Hamilton The undersigned individual, Bruce A. Moller, 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. (3) Upon receipt of S32,300.00 for Contractor's Application Payment No. 1 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 Contractor's Name: This` day of , 2012 Kathryn Notary Public in and for said County and State My commission expires: 4/23/14 Hagerman Construction Corp. Bruce A. Molter Printed name By: ( yl My County of Residence: Marion Executive Vice President (Title) REQUEST FOR PAYMENT ;.,r, r �7 1U CA/ U .j0l1Z 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: 85554 Draw: APP00002 Invoice date: 11/28/2012 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 less retainage Less previous requests Current request for payment Current billing Current additional charges Current tax Less current retainage Current amount due $34,000.00 $0.00 $0.00 $0.00 $0.00 $32,300.00 $0.00 $0.00 -$1,700.00 Remaining contract to bill $0.00 $34,000.00 $34,000.00 $34,000.00 $1,700.00 $0.00 $1,700.00 Project: 12- 3129 -1 P112 East Retaining Wail -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 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 (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 By: Date: f1 /Z-43 State Of er,;r,4- %.0//4.117- County Of Subscribed and sworn to before me this e S' day ofr;,p'. ,�d r Notary Public 4.1,-A., z My commission exp(res:/2, ✓�., ktl KA IO C VtN • " :NOTARY Marion County ,, se& My Commission Expires 'RV/ Apri 23, 2014 REQUEST FOR PAYMENT DETAIL Project: 12- 3129 -1 1 P112 East Retaining WaII -Cer Invoice: 85554 Draw: APP00002 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 Pavers, concrete, caulking etc 34, 000.00 34,000.00 34,000.00 100.00 0.00 Totals 34,000.00 34,000.00 1 34,000.00 00.00 0.00 1 L1C.LR.i: December 12, 2012 Signature Construction 720 3'd Avenue SW Carmel, IN 46032 Fishers, IN 46038 ATTN: Jason Springer RE: P112 East Retaining Wall HCC Project No.: 123124 -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 C STRUQTION CORPORATION Greg Delagrange Project Manager {/77 Hagerman Construction Corporation 10315AInsonvi!le Rd. Fishers, !N 461.:38-2017 uh: ;317: •77 -6836 tx: 1317i 577 -6541 .r:.v ✓.thehagermngrour.cnm