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Home My WebLink AboutSMOCK FANSLER CORPORATION- 002788- 3/22/2012 CARMEL REDEVELOPMENT COMMISSION 002788 Smock Fansler Corporation Check: 2788 2910 W Minnesota Street Date: 3/22/2012 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 5-4 387.00 387.00 0.00 0.00 387.00 motorcourt precast urns 387.00 387.00 0.00 0.00 387.00 i • 4t.72p,F? 0THEKEYTO DOCUMENT.SECURITCCHEATACTIVATEDITHUMBPRINT„°ADDIT_IONALSECURIT.Y,FEATURESINCLUDED SEEBACK.FOR DETAILS` ,, �y 6 D!!� �° \Carmel Redevelopment Commission �Ij RcGtoNS 002788 t2.T 30 West Main Street - 20 u2lnao a :C Suite220 - - f "ra1�-I Carmel; IN 46032 • Dtr .,1 2788 DATE AMOUNT 3/22/2012 387.00 PAY THE SUM�OF THREE HUNDRED EIGHTY SEVEN DOLLARS AND NO CENTS • TO THE ORDER OF ,Smock FanslerCorporation . 2910.W,MinnesotaStreet - Indianapolis, IN 46241-4541 • M ',,... . m ,I ___________ 1'00 2 78811' 1:0 7 4 0 /4 2 L 3 1: 008 7 504 L /ill' -- ---V _. • CARMEL REDEVELOPMENT COMMISSION 002788 • Smock Fansler Corporation Check: 2788 2910 W Minnesota Street Date: 3/22/2012 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 5-4 387.00 387.00 0.00 0.00 387.00 motorcourt precast urns 387.00 387.00 • 0.00 0.00 387.00 1 1-52 COMPUTEREASE FORMS DIVISION(877(577-5781 T-37228 1'2 • `e)c AIA Type Document 1,-) i;v (72, " C� Application and Certification for Payment V" Page 1 of 2 TO(OWNER):CARMEL REDEVELOPEMENT COMM. PROJECT:PRECAST URNS/CARMEL CITY CTR APPLICATION NO: 4 DISTRIBUTION ONE CIVIC SQUARE 30 W.MAIN ST, PERIOD 70:1213012011 TO: CARMEL, IN 46032 CARMEL,IN 46032 _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: 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 $ 51,985.00 2. Net Change by Change Orders $ 0.00 CONTRACTOR: Smock Fansler Corporation 2910 W. Minnesota Street Indianapolis, IN 46245 \ Q`... ' 3.CONTRACT SUM TO DATE (Line 1 + 2). . . . . .. . .. $ 51,985.00 4.TOTAL COMPLETED AND STORED TO DATE i / $ 51.985,00 By: Y �{ / Date: pi / �� l_., _ T.M. FANSLER I CEO •_ - 5, RETAINAGE: - �-•� Slate of:IN a. 0.00%of Completed Work $ 0.00 -i ••• County of: MORGAN b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this Da of /peioti it ref20 3d y /�p�.�ux� 20 1/ Total retainage(Line 5a t 56) $ 0.00 Notary Public: �C./. �„ /� My Commission Expires: f//sc.4g0/ -. 6.TOTAL EARNED LESS RETAINAGE $ 51,985.00 (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- (Line 6 from prior Certificate) $ 46.786.50 prising the above application, the Architect certifies to owner that to the best of the Architect's Wei knowledge,information and belief the Work has progressed as indicated,the quality of the work ll' 8. CURRENT PAYMENT DUE $ 5,198.50 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) $ 0.00 ere 5° AMOUNT CERTIFIED $ '7 r _ (Attach explanation it amount certified lifers from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on t a eet that am changed to conform to the amount certified.) Total changes approved in ARCHITEC 1 previous months by Owner 0.00 0.00 By_ t Date: 244 l r7 , Total approved this Month 0.00 0.00 This Certifl is not nA gotiable. The MOUNT CERTIFIED is payable only to the Contractor named herein. e, Payment and acceptance of payment are without prejudice to any TOTALS 0.00 0-00 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 0.00 (811 r1- L AIA Type Document .• Application and Certification for Payment Page 2 of 2 TO(OWNER):CARMEL REDEVELOPEMENT COMM. PROJECT: PRECAST URNS/CARMEL CITY CTR APPLICATION NO: 4 DISTRIBUTION ONE CIVIC SQUARE 30 W.MAIN ST. TO: CARMEL, IN 46032 CARMEL, IN 46032 PERIOD TO:12/30/2011 _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 MOLD CONSTRUCTION 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00 0.00 0.00 2 PRODUCT PRODUCTION 26,985.00 26,985.00 0.00 0.00 26.985,00 100.00 0.00 0.00 REPORT TOTALS $51,985.00 $51,985.00 $0.00 $0.00 $51,985.00 100.00 $0.00 $0.00 AFFIDAVIT AND WAIVER OF LIEN [X] Final [ ] 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#11-076 Precast Urns n. Carmel City Ctr. 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: ($0.00) [ ] 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($5,198.50) Five Thousand One Hundred Ninety Eight Dollars and 50/100 [ ] receipt of which is hereby acknowledged; or [X] 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. �j �� SMOCK FANSLER CORP. By �/ " 0\�t% �%'r/�'I Title CEO T.M. Fansler WITNESS MY HAND AND NOTARIAL SEAL, this 30th day of December, 2011. �w"`° Y PUg4� ,. o,�p........... 0 , tidg cl ," /d, _ . Melissa J. Bishop Notary ry ublic °* ;. SEE . E My commission expires November 30, 2016 Residing in Morgan County ', 5;r �p�P, Prescribed by Stole Roard of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee SinQc/< htLfjCr Corp. Purchase Order No. I t- IQ N,/. I I inne-10 -4/ S±' Terms rt iAltlpoli $� ZW -( b2- I Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) l2-30_I� 1-,o1or room krg &s+ uirnS 3 erl." Total '58 1.4 I I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct ass • _ : •ited same in accor- dance with IC 5-11-10-1.6. 3-z► , 20 ►2 �� r_ - •- reasurer