HomeMy WebLinkAboutCapitol City Iron Works - Motor Court Stairs - $5,625Exhibit 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 1
Capitol City Iron Works — Appl. 1
$5,343.75
Capitol City Iron Works — Appl. Retainage
$ 281.25
Total Authorized Disbursement
$5,62.5,00
All terms used in these Disbursement Instructions without definition shall have the meanings
ascribed thereto in that certain Loan Agreement (PAC Fixed Seating), dated, as of August 31,
2009, by and between Lender and Village Financial, LLC.
Dated: 14 7 /�J
CITY OF CARMEL REDEVELOPMENT
COMMISSION
By
Printed
e S 5 0(')
Title EX e (w ,rc3c4)G`
CERTI.ATf F (DRRAYMENT
.....
SignaW:"e CODSirDCDOD, LLC
720 Third Ave
Carmel, IN 46032
FROM SUBCONTRACTOR
Cqy iron We! ks
1120 East N,..r.p; 'York Suee:.
IN 46202
CONTRACT POR. Rails
■;..‘,:.,.TiON NO
r:I•I:10I COX', 10th PERIOD TO
NOS
04 ARcHi-F.,oi
C oT4 RAc: pi, vE:
D:St"DUtiGi•' till.
":",12512012
CECI
_._.1CONTRAC.1 OR
913;2012
!ENGINEER
CONTRACTOR'S APPLICATION FC)R, PAYMENT
The crui,fier, ;hat Itie best of ;l's ' and belief the '0.10r1;
co,eried by t4 Appl,oefIon f, z,28,1:-:-T,r'r-1 in 001, lift tiraZ
been Laid by the F.11- for Wodri for issued crib from the
art I(tat curre..,1
Applicaitior: is made "IC: p'e,iyrntrr);. as slicAvn her:. in connection with the Contract
Conlim.ation Sher.;, 414. Document 0703. is a;tached
1 ORIGINAL CONTRACT SUM.. ...... .$
2. Net change by Change Orders
3. CONTRACT SUM TO DATE Ine 1 2)
4. TOTAL COMPLETED & STORED TO DATE. .$
(C."' ,fnn 0 on 0703
5. RETAINAGE;
a. 5 % of Completed Work
(Column s D + E on 0703)
b % of Stored Material
(Column F on G703)
Total Retainage (Line 5a + 5b or
Total in Column I of G7031
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
(Line 6 from prior Ce4rf=10)
8. CURRENT PAYMENT DUE... ....
9. BALANCE TO FINISH; INCLUDING RETAINAGE
(Line 3 less Line 6)
5,625.00
5,625.00
5,625.00
281.25
281.25
SUBCONT
INDI
C n y of MARION
Subscribed and sworn to before
me Ibis 25th day of November, 2012
Notary Public N), r
My Or,m7Issn-,r, 4124/2-0
5,343 75 ARCHITECT'S CERTIFICATE FOR PAYMENT
in em i,rnt with the Cohlreet C'.,,enonfrf based on on-sile and the data mrrwit VHS oriiir:::11lOh, the
Cbr1'ff'-!, to fb. Cvhe, that itisHo the best of the f.,!ii,illtv? WO* has as
0.00 ihdc.-atc.e.i the 01 ;ho is in Consrad twit (tie Subf;‘,.,-Irartnr ;$ ;:,]Yninnt of
the AMOUNT CERTIFten
281.25
5,343.75
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
previous months by Owner
Total approved this Month
TOTALS
$0.00
$0.00
NET CHANGES by Change Order
$0.00
AMOUNT CERTIFIED
(5h F.,p'Fina;ii).-: if f,-i-,01;rf coffers from the applied for. loiha; all on this App!ir;r1tfon and on the
=cf
ARCHITECT.
Th,0 no0
and . I ;:iayrric are
Date.
Tb built (Nit CERTIFIED is hpy1:11,1” only 10 the Cf1n1171.1,1, e1-11-,,s1 IICCI'( rflym,:01
tIr.y 0%-..r.,,r Conrad,,,
(hie C1,4,4
03 CONTNUATION SHEET
To From:
Signature Construction
720 Third Ave
Carmel, Indiana 46032
Capita; CE' Iron Vniorks
920 East Nuw York Street
IndianapoIis. IN 46202
Project
Motor Court Slairs
CarrneL Indiana 46032
PAGE i OF 1 PAGES
AppIicarn No. 1
AppIication Date. 11!25/2012
:period To 11..25.2012
Engineer's 'Project No.
A
B
C
D
E
F
G
WORK COMPLETED
MATERAiLS
TOTAL
FROM PREVIOUS
PRESENTLY
COMPLETED AND
Item
SCHEDULED
APPLICATION
STORED NOT IN
STORED TO DATE
I-3ALANCE TO
[ 4
DESCRIPTION OF WORK
VALUE
(DE)
THIS PERIOD
1) OR E)
(D-tE HI)
% (0/C)
FINISH (C-G)
RETAINAGE
1
Stair Rails
5,625.00
$ 5,625.00
$ 5,625.00
100%
$ -
281.25
$ -
S -
$ -
$ -
$ -
$ -
$ -
$
$ -
$ -
$ -
$
S -
S -
$ -
$ -
$
$ -
$ -
$ -
$
$ -
$ -
$ -
$
$ -
$
$
$ _
$
$ _
$ -
$
S
$
$
_
$
$ -
$
_
$ -
$ _
$ _
$ -
$
$ _
$
$
$ -
$ _
$ -
-
$
$ -
$ 5,625.00
$ -
5,625.00
$ -
5,625.00
5 -
$ 281.25
INTERIM LiEN /CLAIM WAIVER
kks
Contact Person:
Contact Telephone:
(ilea '" Wel
Project
Carmel. IN
tai ajen aemei '-
DJC
PS
Project Manager
Project Telephone :
CONDITIONAL RELEASE
The undersigned does hereby acknowledge that
upon receipt by the undersigned of a check from (Name of
Firm writing chec ' Tie 'edcor Co oanies
in the sum of $ 19Z
and when the chec has been properly endorsed and has
been paid by the bank upon which it was drawn, this
document shall become effective to release pro tanto any
and all claims and rights of lien which the undersigned
has on the above referenced lob. This release covers a
progress payment for labor, services, equipment,
materials (imistie and/or claims through (date)
'a.>
only and does not. ver any retention or items furnished
after that date. Before any recipient of this document
relies on it said party should verify evidence of payment to
the undersigned.
i CERTIFY UNDER PENALTY nF..PF @JURY UNDER
LAWS OF THE STATE OF tJ Iiif..1(`)G\ THAT THE
ABOVE IS A TRUE AND CORRECT STATEMENT.
Signatur
UNCONDITIONAL RELEASE
The undersigned does hereby acknowledge that the
undersigned hac received progress payments in the sum
of $.
for labor, services, equipment or materials furnished to the
above referenced job and does hereby release pro tanto
any and all claims and rights of Gen which the
undersigned has on the above referenced job. This
release covers all payment for labor services, equipment,
materials furnished and /or claims to the above referenced
job through (date)
only and does not cover any retention or items furnished
after that date.
NOTICE; THIS DOCUMENT WAIVES RIGHTS
UNCONDITIONALLY AND STATES THAT YOU HAVE
BEEN PAiD FOR GIVING UP THOSE RIGHTS. THIS
DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU
SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU
HAVE NOT BEEN PAID, USE A CONDITIONAL
RELEASE FORM.
I CERTIFY UNDER PENALTY OF PERJURY UNDER
LAWS OF THE STATE OF THAT THE
ABOVE IS A TRUE AND CORRECT STATEMENT.
Signature:
J
Dated this /f,5111 day of l (AL IA
at:
Subscribed and sworn b feT me day and year first above
;tier ,, +t p'
RO.
Dated this
at:
bi is
Marron County
•
day of
Subscribed and sworn before me day and year first above
written:
Notary Public
My commission expires :
SUBCONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS & WAIVER OF LIEN
STATE OF INDIANA
COUNTY OF MARION
Kip Goatee Being duly sworn upon his /her oath disposes and
says that:
1. He /she is President (inserting sole proprietor, partner or corporate office held, as the case maybe), of
Capitol City Iron Works, Inc. hereafter called the "Subcontractor ". He /she is over the age of twenty -one.
He /she is authorized to make this affidavit on behalf of Subcontractor.
2. Subcontractor is the stairs rails Subcontractor for the construction of the development known as
Motor Court Stairs located in Carnet (City), Indiana (state), hereafter referred to as the "Development',
pursuant to the contract between the Subcontractor and Signature Construction, LLC, the General
Contractor.
3. This affidavit is made for the express purpose of inducing Signature Construction, LLC, to make
payment to Subcontractor of the invoice submitted herewith for labor and materials furnished pursuant to
said Contractor. Upon receipt of said payment the Subcontractor hereby waives any lien rights to which
Subcontractor is entitled for labor or materials furnished for the development to the date hereof.
4. Listed below are all suppliers or other persons who either has furnished or might furnish the
Subcontractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the
development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a
waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case
also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered
to the General Contractor. 3.) If the initial delivery has not been made.
Supplier List (Add list if necessary) 1. Amount Owed
I - -+„ •r- I
ENTURY
#1 and 2 correspond to the same numbered choices on the waiver format. Signature Construction, LLC
is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly
payable to Subcontractor and such creditor, as Signature Construction, LLC shall determine.
5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result
in lien being filed against the Development or a claim being asserted against the General Contractor
except the persons or businesses named in Paragraph 4 above.
IN WITNESS WHERE OF, affiant has signed this do imen behalf of the Subcontractor this 25th
day of November, 2011
County of MARION
State of INDIANA
}
)
Subscribed and sworn to before rile, a Notary Public in and for said
Day of November , 2011 it (),"
o
e%es-ntative of Subcontractor)
v
(Notary Public)
Monica Ward -Tyler
My Commission Expires: 4/24/16 (Printed Name)
NOTARY SEAL MUST APPEAR ON THIS FORM, (Revised 10/2000 SignatUr
aunty and S ;art�l,ilTii }�r225
cc f =
..off` •`
IND\
LICATION AND iFICATE FOR PAYM:.,.
Signature Con,;: uction, LL,'_
720 Third Ave
Carmel, IN 46032
PROM SUBCONTRACTOR.
Cap lot City lion '.'for.__
920 East New ST:ee
Indianapolis, IN 45202
CONTRACT FOR Rails
Jrvii.:N .;/02
t>•J 1C(, ?- -- ,__— __....,._. raPt'L(,A.1 ION ..
i.lotci Cut:r, Stairs
S ir4 46032
VIA AR CH i'f EC T .
. ,,`'r.' Ghr ./F
E AINAGE
PERIOD TO 11;25/2012
PROJECT NOS
CONTRACT DAVE 911312312
!LED
O'A/rJ L R
!Cur.!
ENC INES..N
CONTRACTOR'S APPLICATION FOR PAYMENT
is made for payment as <_norm belve• +, in connection with the Contract.
_nrtinuatlon Sheet. AIA Document 6703. is attached.
1 ORIGINAL CONTRACT SUM.. .. . . ...S
2. Net change by Change Orders $
3. CONTRACT SUM TO DATE (Line 1 +1- 2) $
4. TOTAL COMPLETED & STORED TO DATE.. _ _$
(Column Gan G703)
5. RETAINAGE:
a ._5_ % of Completed Work $
(Column s D + E on G703)
b. % of Stored Material $
(Column F on G703)
Total Retainage (Line 5a + 5b or
Total in Column I of G703) $
6. TOTAL EARNED LESS RETAINAGE $
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
(Line 6 from prior Corr f'c:-tn) $
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 Less Line 6) $
5,625.00
5,625.00
5,625.00
0.00
5,625.00
5,343.75
281.25
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
previous months by Owner
Total approved this Month
TOTALS
30.00
S0.00
NET CHANGES by Change Order
$0.00
that
,...5, ot Ste � .. �. s ;;,nr . -•_ - -. •.,•` and bulit2.1 .._ `J;_r.
.. '.:.: C' by th:c �, :. ;i, :.,, (':., ., _:',' .,, :� t,'•rn �, , .: ir, a;' _... ,_ 't..;; � nfiatJ (;nr.,i ,iF•,, ... r..,, .� -. .,_
been /;aid by the °,&.. , for Work which previcus Cr n.,..: for Payment were issued and ; , c +.. _ ; from the
Coa,rac:et, and Itiaicurreef
SUBCO
By:
St .e o ' NDIANA
Cot ty of. MARION
Subscribed and sworn to uefore
me this 25th day of November, 2012
Notary Public) r tt
My Ccrr.— rnr, _ t 41
''TT
NO74$H ��
ARCHITECT'S CERTIFICATE FOR PAYMENT
In 'rrc,..lr,n. -F with the (ln "ir=„-r t,rrt;incnt-. based on nn-site obsenr,rn,,e and the data rnmiiit tnti; :his art ,..bf';'... the
"r ^`it,oct codif.t,a to ht,ri Ca,,.cr that to the best of the t ... en's k^, a r•4rr ninom y,
;iah�n and hrlir {enR �,d. has rncrnr, rt as
ir. ;'.,rr=tr the -i :Miry .0 the I.Nork is in ;n-rr,y0nr., ;hr r„ r -
cnuaci D-... :,rd., and the BubCr,. ^.nor :. -, fs r ... r: to pv'^-, :,t of
the Atr10UNT CERTIFIED.
AMOUNT CERTIFIED..
(Alta l; A, rf.Sr., ;G :•n d . cr' ;�c;' duets from the :rr,nunr appli ?d for inittal all frgumS or; this Pprnrhrn acid on Me
Con1`rn:nti•,-, Sheet that Are - nd' -....,nrrn to
ARCHII TTECT-
By ► 1 Date. 12,
This Certitirmn is n ., 03C.t Jh ±n. The f'Atr)UPt f CER-nrIED is peyeS" only to ihn t:sntra7, .r
.. .
r,� (SSUan�F
, , r ,•
and , - eit,, 10 r or Cnn ±r= rtnr under this Contract.
G703 CONTINUATION SHEET
To:
Signature Construction
720 Third Ave
Carmel, IN 46032
From:
Capitol City Iron Works
920 East New York Street
Indianapolis, IN 46202
Project:
Motor Court Stairs
Carmel, IN 46032
PAGE 1 OF 1 PAGES
Application No: Retainage
Application Date: 11/25/2012
Period To: 11/25/2012
Engineer's Project No:
A
B
G
D
E
F
G
H
I
J
WORK COMPLETED
COST CODE
DESCRIPTION OF WORK
SCHEDULED
VALUE
FROM PREVIOUS
APPLICATION
(D +E)
THIS PERIOD
MATERAILS
PRESENTLY
STORED (NOT IN
D OR E)
TOTAL
COMPLETED AND
STORED TO DATE
(D +E +F)
% (G/C)
BALANCE TO
FINISH (C -G)
RETAINAGE
1
Stair Rails
$ 5,625.00
$ 5,343.75
$ 281.25
$ 5,625.00
100%
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ 5,625.00
$ 5,343.75
$ 281.25
$ -
$ 5,625.00
$ -
$ -
INTERIM L IEN /CLAIM WAIVER
14f�t r xrleaa • e
4 1K
y ' (Dv, Stalc, Gp,axle
Contact Person: . t _�i_i � t: r
Contact Telephone: I U
U"'
Project
Project 1 t.) Pt ' 6,)
1 -robed „mme)
Carmel. IN
(Proved Aduress)
Project Manager:
Project Telephone :
CONDITIONAL RELEASE .
The undersigned does hereby acknowledge that
upon receipt by the undersigned of a check from (Name of
Firm writing check): T rCorn .enies
in the sum cf $ r 7
and when the check has been properly endorsed and has
been paid by the bank upon which it was drawn, this
document shall become effective to release pro tanto any
and all claims and rights of lien which the undersigned
has on the above referenced job. This release covers a
progress ayment for labor, services, equipment,
materia7 Eris and /or claims through (date)
only and oes n too er any retention or items furnished
after that data Before any recipient of this document
relies on it said party should verify evidence of payment to
1 the undersigned.
I CERTIFY UNDER PENALTTY f?F`JURY UNDER
LAWS OF THE STATE OF 4 \\ �" THAT THE
ABOVE IS A TRUE AND CORRECT STAT MENT.
Dated this P\ _ day of
at:
Subscribed an worn bet F me day and year first above
Mt' :``\ \0,'N,NrAR r,; / r r\
0,0' ' LiVi4p isbbm. Expires /' `�' <s
;$otter
-rk '.•
yom t
UNCONDITIONAL RELEASE
The undersigned does hereby acknowledge that the
undersigned has, received progress payments in the sum
of S
for labor, services, equipment or materials furnished to the
above referenced job and does hereby release pro tanto
any and all claims and rights of lien which the
undersigned has on the above referenced job, This
release covers all payment for labor services, equipment,
materials furnished and /or claims to the above referenced
job through (date)
only and does not cover any retention or items furnished
after that date.
NOTICE: THIS DOCUMENT WAIVES RIGHTS
UNCONDITIONALLY AND STATES THAT YOU HAVE
BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS
DOCUMENT 15 ENFORCEABLE AGAINST YOU IF YOU
SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU
HAVE NOT BEEN PAID, USE A CONDITIONAL
RELEASE FORM,
I CERTIFY UNDER PENALTY OF PERJURY UNDER
LAWS OF THE STATE OF THAT THE
ABOVE IS A TRUE AND CORRECT STATEMENT,
Signature:
(AW:onzen arpo; bh.mi arvie7Uwrrer)
Dated this
at:
(i ttt2;1
day of
Subscribed and sworn before me day and year first above
written:
Notary Public
My commission expires :
SUBCONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS & CONDITIONAL FINAL WAIVER OF LIEN
STATE OF INDIANA
COUNTY OF MARION
Kip Goatee Being duly sworn upon his/her oath disposes and
says that:
1. He /she is President (inserting sole proprietor, partner or corporate office held, as the case maybe), of
Capitol City iron Works, Inc. hereafter called the "Subcontractor". He /she is over the age of twenty -one.
He /she is authorized to make this affidavit on behalf of Subcontractor.
2. Subcontractor is the stair rail Subcontractor for the construction of the development known as Motor
Court Stairs located in Carmel (City), Indiana (state), hereafter referred to as the "Development",
pursuant to the contract between the Subcontractor and Signature Construction LLC, the General
Contractor
3. This affidavit is made for the express purpose of inducing Signature Construction LLC, to make final
payment to Subcontractor for labor and materials furnished pursuant to said Contractor. Upon receipt of
said final payment in the amount of $281.25 the Subcontractor hereby waives any lien rights to which
Subcontractor is entitled for labor or materials furnished for the development to the date hereof.
4. Listed below are all suppliers or other persons who either has furnished or might furnish the
Subcontractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the
development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a
waiver of lien by supplier conditioned by payment of a specified amount is attached hereto, (In this case
also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered
to the General Contractor. 3.) if the initial delivery has not been made.
Supplier List (Add list if necessary
1, Amount Owed
3
T
•0 •
Utt PAIL) IN
v?
#1 and 2 correspond to the same numbered choices on the waiver format. Signature Construction, LLC
is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly
payable to Subcontractor and such creditor, as Signature Construction, LLC shall determine.
5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result
in lien being filed against the Development or a claim being asserted against the General Contractor
except the persons or businesses named in Paragraph 4 above.
IN WITNESS WHERE OF, affiant has signed this docunynt on
of November , 2012.
County of MARION
State of INDIANA
If of the Subcontractor this 25'x' day
1 �.rs
Airy 4%
nta we of Subcontractor)
•ri&esj - re'r
Subscribed and sworn to before{ ie a,Notary Publi i i,and \for said County and State, this 25th Day of
November. 2012. E f i tl "Du r1f /9 7/ J
(Notary Public) tf \\�\\ , t \A
Monica Ward -Tyler
My Commission Expires: 4/24/16 (Printed Name) edem :�
NOTARY SEAL MUST APPEAR ON THIS FORM. (Revised 10/2000 Si g ) nIturr ' ` W -
gy
-^- •v
��I�P
le fie,
.,fitDI•�i=a
Financial, LLC any an
and /or materials,d
Contractor on
section of that Affidavit
Attachment A
TRANSFER OF TITLE
4 } ("Contractor") transfers to Village
all right, title and/or interest that Contractor has in any labor
ed in (i) t t„Affiday't of Waiver of Lien executed by the
, 20 , and (ii) in the `` o nt of this R-eque _ ,'
executed by the Contractor on ` t, ( , 20.
3
d'
..• 1-U1
November 25, 2012
Signature Construction
720 Third Ave., SW
Carmel, IN 46032
RE: Motor Court Stairs
Dear Sir or Madam:
If, within one year after the date of the architects substantial completion, any
of the work is found to be defective Capitol City Iron Works, Inc. shall
correct it promptly after receipts of written notice from the owner to do so.
All materials and equipment furnished by Capitol City Iron Works, Inc. is
new unless otherwise specified by the contract. All work was performed in
a workmanlike manner and in accordance with standard practice.
Capitol ity on Works, Inc.
ip Goo
President
920 E. New York Street Indianapolis, IN 46202
317 - 263 -5080 • Fax 317 -263 -5098 • www.capitolcityironworks_com