SMOCK FANSLER CORPORATION -001695 -3/3/2011 CARMEL REDEVELOPMENT COMMISSION U U 1 b
Smock Fansler Corporation Check: 1695
2910 W Minnesota Street Date: 3/3/2011
Indianapolis, IN 46241-4541 Vendor: SMOCKFA1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
3059 41,438.70 41,438.70 0.00 0.00 41,438.70
P111 Pavers through 01/31/2011
41,438.70 41,438.70 0.00 0.00 41,438.70
1
REQUEST FOR PAYMENT
From: Smock Fansler Corporation To: CARMEL REDEVELOPMENT COMMISSION Invoice: 3059
2910 W. Minnesota Street 30 W.MAIN ST. Draw: APP00006
Indianapolis, IN 46241-4541 CARMEL, IN 46032 Invoice date: 1/21/2011
Period ending date: 1/31/2011
Contract For:
Request for payment:
Original contract amount $805,860.00
Approved changes $23,800.00 Project: 10081
Revised contract amount $829,660.00 P. 111 PAVERS
Contract completed to date $547,656.00 Contract date:
Add-ons to date $0.00
Taxes to date $0.00
Architect:
Less retainage $54,765.60
Total completed less retainage $492,890.40 Scope:
Less previous requests $451,451.70
Current request for payment $41,438.70
Current billing $46,043,00
Current additional charges $0.00
Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Less current retainage $4,604.30 Changes approved in previous 10.300.00
Current amount due $41,438.70 months by Owner
Total approved this Month 13,500.00
Remaining contract to bill $336,769.60 TOTALS 23.800.00
NET CHANGES by Change Order 23,800.00
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 CARMEL REDEVELOPMENT COMMISSION relating to the above referenced project. I also
certify that the contractor has paid all amounts previously billed and paid by the owner. i,';!•!iN° .
CONTRACTOR: Smock Fansler Corporation State Of INDIANA County Of MORGAN
By `Y' /)7 . 471 ,,-(--- --" Subscribed and sworn to before me this /},//�""day of ,_.1{;>,'lcdr;,;',t , , ;2(?// '••-f '•
Date: 7/ ?.? / ,f/ Notary Public `,�,�1• ,J.rs;.t! 1,7/._ �f. ., e
/ .41 My commission expires: j /
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�t// Director of Redevelopment J/-{-{(�0' U 5
REQUEST FOR PAYMENT DETAIL
Project: 10081/P.111 PAVERS Invoice: 3059 Draw:APP00006 Period Ending Date: 1/31/2011 Detail Page 2 of 2 Pages
Item ID Description Total Previously Work Presently Completed % Balance Retainage
Contract Completed Completed Stored And Stored Comp To Balance
Amount Work This Materials To Date Finish
Period
01 MOBILIZATION 10,000.00 5,000.00 5,000.00 50.00 5,000.00 500.00
02 FIELD ENGINEERING 10,000.00 6,500.00 6,500.00 65.00 3,500.00 650.00
03 ASPHALT BASE 165,400.00 148,860.00 8,270.00 157,130.00 95.00 8,270.00 15,713.00
04 UNIT PAVERS 620,460.00 341,253.00 31,023.00 372,276.00 60.00 248,184.00 37,227.60
05 CHANGE ORDER#1 10,300.00 10,300.00
06 CHANGE ORDER#2 13,500.00 6,750.00 6,750.00 50.00 6,750.00 675.00
Totals 829,660.00 501,613.00 46,043.00 547,656.00 66.01 282,004.00 54,765.60
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: Cannel Redevelopment Commission to furnish certain labor, materials,
and/or services as follows: Misc. Construction for a project known as: SFC#10-081 P. 111 Pavers
located at Cannel,IN and does hereby state on behalf of the aforementioned contractor:
(PARTIAL WAIVER)that there is due from the owner the sum of: (S41,438.70)
Forty One Thousand Four Hundred Thirty Eight Dollars and 70/100
[ receipt of which is hereby acknowledged;or
[X] 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(50.00)
[ ] 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 cf 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 ., / • ` ° .=Fit}e CEO
T.M. Fansler
WITNESS MY HAND AND NOTARIAL SEAL,this 21' day of January,2011.
1-4
Melissa J. Bishop No ry Public
My commission expires November 30, 2016 Residing in Morgan County