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Gibraltar - Motor Court Exterior Wall - $16,542.50
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 Exterior Wall installment purchase contract Application 3(Gibraltar) January 2012 $ 16,542.50 Total Authorized Disbursement $ 16,542.50 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: ZA, /I2 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. Motor Court Exterior Wall (Gibraltar Construction) October 2011 Application 1 Paid by Carmel Theater Development $ 39,645.00 November 2011 Application 2 Paid by Carmel Theater Development $ 99,005.00 January 2012 Application 3 Amount to be paid by Carmel Theater Development $ 16,542.50 =_N.AIA Document G732 TM - 2009 Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: Carmel Theater Development Company PROJECT: Motor Court P112 Veneer APPLICATION NO: 3 DISTRIBUTION TO: 11711 North Pennsylvania Street,Suite 200 OWNER Carmel,IN 46032 PERIOD TO: 1/23/12 CONSTRUCTION MANAGER _ FROM Gibraltar Construction Corp VIA CONSTRUCTION CONTRACT DATE: 7/5/11 ARCHITECT _ CONTRACTOR: 2932 N.Webster Ave. MANAGER: PROJECT NOS: / I CONTRACTOR Indianapolis,IN 46219 FIELD CONTRACT FOR: Motor Court P112 VIA ARCHITECT: Pedcor Design Group OTHER CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor erti ti's that to the best of the Contractor's knowledge,information and belief the Work covered by ii is •I plication for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,tha 47am. is have been paid by the Contractor for Work for which previous AIA Document G7O3TM,Continuation Sheet,is attached. Certificates for Payment 11�/ff:`e iss' d and payments received from the Owner,and that current payment 1.ORIGINAL CONTRACT SUM S 201,000.00 shown herein is now du/14, 2.NET CHANGES IN THE WORK S 0.00 CONTRACTOR: GI i/ • stntctlon Corp 3.CONTRACT SUM TO DATE(Line I_2) S 201,000.00 By: Date: C /� .2/2— 4.TOTAL COMPLETED AND STORED TO DATE(Column C on G703) 5 168,650.00 State of • igr 3.RETAINAGE: County of: fr.1 yy BRIAN R. MCBRIDE a. %of Completed Work Subscribed an, .tom to b- ors.... ` Res. of Hancock County (Column D+Eon G703) $ 13,457.50 me this day o / My Comm, En. 11-29-2017 b. %of Stored Material Notary P '_..••S- Commission #611862 (Column:F:on G703) $ My Commission expires: - Total Retainage(Lines 5a+56,or Total in Column n G703) $ CERTIFICATE FOR m ,r PAYMENT 5.TOTAL-EARNED LESS RETAINAGE $ 155,192.50 In accordance with the Contract Documents,based on evaluations of the Work and the data comprising (Line 4 minus Line 5 Total) this application,the Construction Manager and Architect certify to the Owner that to the best of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT 138,650.00 knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT 8.CURRENT PAYMENT DUE $ 18.542.50 CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED $ \ 01 c'D (Attach explanation if amount certified differs from the amount applied.Initial all figures on this (Line 3 minus Line 6) $ 45,807.50 Application and on the Continuation Sheet that are changed to conform with the amount certified.) CONSTRUCTIO M N G nature Construction,LLC / By: i.. Date: f /r}S"/f 1 SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS ARCHI ECT: 1 OTE.�If�a fultiple Prime Contractors are responsible forperjorntating portions of the Total changes approved in previous months by Owner S $ Project, th t chite 's ert(cation is not required.) Total approved this month,including Construction Change By: ,—t `\r Date: \'L__-. _Directives.-. $ $ This Certific i is not negotiable:The AMOUNT CERTIFIED is , .ble o ly to the Contractor named TOTALS $ $ herein.Issu ee,payment and acceptance of payment are with.rt p •judi • to a y rights of the Owner NET CHANGES IN THE WORK $ or Conti' or under this Contract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not he obscured. I!a //3D/(Z AIA Document G732,,--2009(formerly G702T°CMa—1992).Copyright©1992 and 2009 by The American Institute of Architects.All rights reserved.WARNING:This AIA Document is protected by U.S.Copyright Law and international Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the taw.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.erg. CONTINUATION SHEET Page 2 of 2 . APPLICATION NO. : 3 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION DATE: 1/20/2012 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where PERIOD TO: 1!31!2012 variable retainage for line items may apply. ARCHITECTS PROJECT NO. • A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE TO ITEM DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS PRESENTLY COMPLETED AND % FINISH RETAINAGE NO. APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G!C) (IF VARIABLE RATE) (D+E) DORE) (D+E+F) (C G) Base BId 1 Allowance $25,000.00 $0.00 0% 25,000.00 2 Mobilization $8,500.00 $8,500.00 $8,500.00 100% - 3 Submittals-Base Bid $13,550.00 $13,550.00 $13,550.00 100% - 4 Earth Moving $3,000.00 $0.00 0% 3,000.00 ■5 Lawns and Grasses $1,100.00 $0.00 0% 1,100.00 6 Masonry $124,500.00 $106,435.00 $18,065.00 $124,500.00. 100% - 13,457.50 7 Electrical $18,850.00 $16,965.00 $1,885.00 $18,850.00 100% - 8 Joint Sealants/Waterproofing $6,500.00 $3,250.00 $3,250.00 50% 3,250.00 . 1 L $201,000.00 $148,700.00 $19,950.00 $0.00 $168,650.00 84% $32,350.00 $13,457.50 Y ISA Form#1-402 4110111k. AFFIDAVIT AND WAIVER OF LIEN ❑ FINAL ►Z/ PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and/or labor for a project known as Motor Court P112 Veneer and owned by Carmel Theater Development Company and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the Owner the sum of Sixteen Thousand Five Hundred Forty Two- —50/100 Dollars ($16,542.50 ❑ receipt of which is hereby acknowledged; or • the payment of which has been promised as the sole consideration 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 Dollars 0 ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THERFORE, 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 ther=• ac •unt of LABOR or material or both,furnished by the undersigned thereto, subject to limitations of conditions e �'ed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work p�� .4v y-d or material furnished to the undersigned project, for said roject, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By /!At/ Title President WITNESS MY HAND AND NOTORIAL SEAL, this 23rd • January, 2012. (Notary Public) D 19 73 INDIANA Su*CONTRAC11OM S ASSOCIATION ►NCOMIQAAT,D ,.k" BRIAN R. M C B R I D E unaut•o?.pos ft aoivawn•••o•••tmoci z .'_ Res. of Hancock Cove*" 1aa * SEAL * My Comm. Exp. 11-29-2017 • o 104 Commission # 611862