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Home My WebLink AboutSMOCK FANSLER CORPORATION -002314 -9/22/2011 CARMEL REDEVELOPMENT COMMISSION 002314 Smock Fansler Corporation Check: 2314 2910 W Minnesota Street Date: 9/22/2011 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-12 41,483.00 41,483.00 0.00 0.00 41,483.00 Retainage balance 41,483.00 41,483.00 0.00 0.00 41,483.00 • . AIA Type Document \a 03 Application and Certification for Payment 4110 g� `I.of 2 n TO(OWNER):CARMEL REDEVELOPMNT COMMISSION PROJECT:P. 111 PAVERS APPLICATION NO: 12 ASP L DISC FdI�UTION 30 W. MAIN ST. TO CARMEL, IN 46032 PERIOD 70:8/31/2011 �-��._OWNER '_ARCHITECT _CO-RTRACTOR FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S 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 $ 805,860.00 \s �,,gY P(Jlg<� 2. Net Change by Change Orders $ 23,800.00 CONTRACTOR: Smock Fansler Corporation o �O.•'' C 2910 W. Minnesota Street Indianapolis, IN 46241 • 3.CONTRACT SUM TO DATE(Line 1 +2) $ 829,660.00 -•, 1 4.TOTAL COMPLETED AND STORED TO DATE $ 829,660.00 By: i • L Date: /. T.M. FANSLER / CEO — 5. RETAINAGE: State of: IN /'i S ' •. ** - a. 5.00%of Completed Work $ 41,483.00 County of: MORGAN / ''It OF INC�P\ b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this Day of uS� 20 // Total retainage(Line 5a+5b) $ 41,483.00 Notary Public: ` 72,_ ,t;QQ' My Commission Expires: / / /y/// 6.TOTAL EARNED LESS RETAINAGE $ 788,177.00 (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 corn- (Line 6 from prior Certificate) $ 746,694.00 prising the above application, the Architect certifies to owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated,the quality of the work 8.CURRENT PAYMENT DUE $ 41,483.00 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED. (Line 3 less Line 6) $ �/y d U4 $ 1 1 4'��3 AMOUNT CERTIFIED (Attach explanation if amount certified differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the -:rttinuation Sheet that are changed to conform to the amount certified.) j,G Total changes approved in ARCHITECT: /_ fly previous months by Owner 23,800.00 0.00 By: l-.�E 1 Date: OZ.)-;-)1t This Certifica : ne �iable. The AMOUNT CERTIFIED is a abl- onl, to the Contractor Total approved this Month 0.00 0.00 9 P Y named herein. Issuance, Payment and acceptance of payment are w'hout .rejudice toany TOTALS 23,800.00 0.00 rights of the Owner or Contractor u der this Contract. /�r/' d69‘---NET CHANGES by Change Order 23,800.00 Cn� 7...- P quilt • - - AIA Type Document Application and Certification for Payment Page 2 of 2 TO(OWNER):CARMEL REDEVELOPMNT COMMISSION PROJECT:P. 111 PAVERS APPLICATION NO: 12 DISTRIBUTION 30 W. MAIN ST. TO: CARMEL, IN 46032 PERIOD TO:8/31/2011 _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 % BALANCE RETAINAGE 1 MOBILIZATION 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00 0.00 500.00 2 FIELD ENGINEERING 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00 0.00 500.00 3 ASPHALT BASE 165,400.00 165,400.00 0.00 0.00 165,400.00 100.00 0.00 8,270.00 4 UNIT PAVERS 620,460.00 620,460.00 0.00 0.00 620,460.00 100.00 0.00 31,023.00 5 CHANGE ORDER#1 10,300.00 10,300.00 0.00 0.00 10,300.00 100.00 0.00 515.00 6 CHANGE ORDER#2 13,500.00 13,500.00 0.00 0.00 13,500.00 100.00 0.00 675.00 REPORT TOTALS $829,660.00 $829,660.00 $0.00 $0.00 $829,660.00 100.00 $0.00 $41,483.00 • 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 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 Carmel,IN and does hereby state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the owner the sum of: ($41,483.00) Forty One Thousand Four Hundred Eighty Three Dollars and No/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($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 V AI, //t`•_: / le CEO T.M. Fansler WITNESS MY HAND AND NOTARIAL SEAL,this 5th day of August ,2011. oO` �PR�' PrlUg`�OOi�, ��•. ..Z. V27-6444 � uMelissa J. Bishgp Nota blic — �-- _ S • . ••My commission expires November 30, 2016_ Residing in Morgan County %,STgT