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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