HomeMy WebLinkAboutSignature, Smock - Motor Court Fountain Rough In - $13,165.97 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
Fountain Rough-In installment purchase contract
Application 4(Smock) September 2011 $ 12,164.40
Application 4(Signature) September 2011 $ 1,001.57
Total Authorized Disbursement $ 13,165.97
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: // 3/// 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.
Fountain Rough-in
(Smock Fansler)
June 2011
Application 1
Paid by Carmel Theater Development $ 22,050.00
July 2011
Application 2
Paid by Carmel Theater Development $ 60,822.00
August 2011
Application 3
Paid by Carmel Theater Development $ 26,607.60
September 2011
Application 4
Amount to be paid by Carmel Theater Development $ 12,164.00
AIA Type Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):CARMEL THEATER DEV.CO. PROJECT:MOTOR COURT FOUNTAIN APPLICATION NO:4 DISTRIBUTION
11711 N PENNSYLVANIA ST. 11711 N PENNSYLVANIA ST. TO:
CARMEL,IN 46032 CARMEL,IN 46032 PERIOD 70:9/30/2011 _OWNER
_ARCHITECT
_CONTRACTOR
FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECTS
2910 W.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 $ 122,500.00 ( 0 . "r^c,'f
2.Net Change by Change Orders $ CONTRACTOR: Smock Fansler Corporation
12,660.00 :�`' •' • '� ,1.
2910 W.Minnesota Street Indianapolis,IN 46241 •.
3.CONTRACT SUM TO DATE(Line 1 +2) $ 135,160.00 `` r._
Ec 135,160.00 By: �V/ [r it� i
4.TOTAL COMPLETED AND STORED TO DATE $ / Bate:
T.M.FANSLER / CEO --"
5.RETAINAGE: State of:IN l
a. 10.00%of Completed Work $ 13,516.00 -417..&- .000°
County of: MARION �ib1//; OIFI 4,N�,`�\c`.`
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this ., d r�i. Day of ,,JV .7/1.05(.' 20 f f
r !
Total retainage(Line 5a+5b) $ Notary Public: c 7Z, �
13,516.00 �� G�f/tad
My Commission Expires: I f I(/�11��
6.TOTAL EARNED LESS RETAINAGE $ 121,644.00
(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 observations and the data com-
prising prising the above application, the Architect certifies to owner that to the best of the Architect's
(Line 6 from prior Certificate) $, knowledge,information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE $ 12,164.40 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
AMOUNT CERTIFIED.
9.BALANCE TO FINISH,INCLUDING RETAINAGE �r
(Line 3 less Line 6) $ 13,516.00 ' , 14'4. q°AMOUNT CERTIFIED $
(Attach explanation if amount certifie.differs from the amount applied.Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on .e Contin .:lion S eet that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT: / p
previous months by Owner 12,660.00 0.00 By: _��_�/�*,....., Date: 4q12.4c,1 1�
Total approved this Month 0.00 0.00 This Certificate is of -gotiable. The AMOUNT CERTIFIED is payable only to the Contractor
named herein.Issuance,Payment and acceptance of paymen without prejudice to any Aijoa TOTALS 12,660.00 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 12,660.00
Cm CL'"`r 431)act I n fz,,
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):CARMEL THEATER DEV.CO. PROJECT:MOTOR COURT FOUNTAIN APPLICATION NO:4 DISTRIBUTION
11711 N PENNSYLVANIA ST. 11711 N PENNSYLVANIA ST. TO:
CARMEL,IN 46032 CARMEL,IN 46032 PERIOD TO:913012011 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 ado BALANCE RETAINAGE
1 MOTOR COURT FOUNTAIN 122,500.00 110,250.00 12,250.00 0.00 122,500.00 100.00 0.00 12,250.00
2 LIGHTING PACKAGE INCREASE 12,660.00 11,394.00 1,266.00 0.00 12,660.00 100.00 0.00 1,266.00
REPORT TOTALS $135,160.00 $121,644.00 $13,516.00 $0.00 $135,160.00 100.00 $0.00 $13,516.00
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 Theater Development Co. to furnish certain labor, materials, and/or
services as follows: Misc. Construction for a project known as: SFC#11-006 Motor Court Fountain
located at Carmel,IN and does hereby state on behalf of the aforementioned contractor:
(PARTIAL WAIVER)that there is due from the owner the sum of: ($12,164.40)
Twelve Thousand One Hundred Sixty Four Dollars and 40/100
[ ] receipt of which is hereby acknowledged;or
[X] the payment of which has been promised as the sole wnsideration 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($0.00)
[ ] receipt of which is hereby acknowledged;or
[ ] 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. By_
- tte CEO
T.M.Fansler
20th ` .>iaa lii mie;trtt�urirn
WITNESS MY HAND AND NOTARIAL SEAL, this 20 day of September ,2011. , ' RY p &r�>i„
Melissa J.Bishop Notary/ ublic "+•
•
My commission expires November 30,2016 Residing in Morgan Count y
OF IhDt��,.`
'1 p,lr%na pIri?;k\ `1
Fountain Rough-in
(Signature Construction)
June 2011
Application 1
Paid by Carmel Theater Development $ 1,225.00
July 2011
Application 2
Paid by Carmel Theater Development $ 7,200.10
August 2011
Application 3
Paid by Carmel Theater Development $ 4,089.33
September 2011
Application 4
Amount to be paid by Carmel Theater Development $ 1,001.57
APPLICATION AND CERTIFICATION FOR PAYMENT A IA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Motor Court Fountain APPLICATION NO Invoice#4 1 Distribution to:
Carmel Indiana 46032 Signature costs OWNER
ARCH ITECT
PERIOD TO: 9/25/2011 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 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,ALA 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.
1. ORIGINAL CONTRACT SUM $ 13,516.00
2. Net change by Change Orders $ 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1+2) $ 13,516.00
4. TOTAL COMPLETED&STORED TO $ 13,516.00 /
By: f r — • Date: /I L 3 /I
5. RETAINAGE: 1.•mas E. . ntz,President
a. 0%of Completed Work $ 0 Subscr..ed and s w'rn to before me this ,,,7,3"-"- of . Ze I/ . . .
( orn D-I-Eon G703)
b. %of Stored Material $ • 4..' '.f.',:\"'
LINDA G.BUCHANAN
•NOTARY•• t Hancock County
(Column F on G703) N• slsnt My Commission Expires
Total Ketamage(Lines 5a+36 or •�; Y p
�'F•:142P ` Au Ust 20 2019
Total in Column I of G703) $ 0.00 AKGHIIEGl'5 GERFIFI A I E FUN I'AYMEN
6. TOTAL EARNED LESS RETAINAGE $ 13,516.00 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) $ 12,514.43 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 1,001.57 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED $ fOO/.0
CHANGE ORDER SUMMARY AUDI I IONS DEDUC I IONS (Attach explanation if amount certified di/j='-s from the amount applied.Initial all figures on this
I otal changes approved Application and onthe • ra'.n •et la a a e changed to conform with the amount certified.)
in previous months by Owner ARCHITECT:
Total approved this Month By: !�e, 1 Date: 91461 o
TOTALS $0.00 $0.00 This Certificat is not n.:oti6ble. h V MNT C RTIFIED is payable only to the
Lomractor name. nerein issuance,payment ano acceptance of payment are wttnout
NET CHANGES by Change Order $0.00 prejudice to any rig' • . 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., .,WA INGTON,DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity fr the L• ens-
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 4
9/25/11
Motor Court Fountain
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 6,758.00 6,432.23 325.77 0.00 6,758.00 100% 0.00 6,758.00
Construction Management Fee 6,758.00 6,082.20 675.80 0.00 6,758.00 100% 0.00 6,758.00
13,516.00 12,514.43 1,001.57 0.00 13,516.00 100% 0.00 13,516.00
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 Fountain, 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 one thousand
one dollars and fifty-seven cents ($1,001.57) the
payment of which has been promised as the sole consideration for this Affidavit
and Conditional Waiver of Lien which is given to and for said amount, effective
upon receipt of such cash payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any
and all line or claim whatsoever on the above-described property and improvements
thereon on account of labor or material or both, furnished by the undersigned thereto, and
further certifies that no other party has any claim or right to a lien on account of any
work perform or material furnished to the undersigned for the said project, and within the
scope of this affidavit and waiver.
SIGNATURE CONSTRUCTION, LLC
T omas . oontz, President
SLr scribed and sworn to before me this: 3 •.D-o//
Notary Public:
..oFF4, LINDA G.BUCHANAN
Hancock County
N: SEA My Commission Expires
'"1$§,;,;!:;':.!‘•". 2019