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HomeMy WebLinkAboutSMOCK FANSLER CORPORATION- 4- 11/23/2011 Smock Fansler Corporation Check: 4 2910 W Minnesota Street • Date: 11/23/2011 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 5 - Hanover 100 20,060.75 20,060.75 2,006.07 0.00 18,054.68 Hanover Fountain (IPC - Merc) 20,060.75 20,060.75 2,006.07 0.00 18,054.68 4 11/23/2011 *""*1'18,054.68 THE SUM OF EIGHTEEN THOUSAND FIFTY FOUR DOLLARS AND 68 CENTS ****************""*"" Smock Fansler Corporation 2910 W Minnesota Street Indianapolis, IN 46241-4541 Smock Fansler Corporation Check: 4 2910 W Minnesota Street Date: 11/23/2011 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 5 - Hanover 100 20,060.75 20,060.75 2,006.07 0.00 18,054.68 Hanover Fountain (IPC- Merc) 20,060.75 20,060.75 2,006.07 0.00 18,054.68 AIA Type Document V'< 11371 Application and Certification for Payment Page 1 of 2 TO(OWNER):VILLAGE FINANCIAL LLC PROJECT:HANOVER SO FOUNT©CITY CTR. APPLICATION NO: 5—S DISTRIBUTION 7703RD AVENUE SW 7703RD AVENUE 6'W PERIOD T0:9/30/2011 TO: CARMEL,IN 46032 CARMEL,IN 46032 —OWNER _ARCHITECT _CONTRACTOR FROM(CONTRACTOR):Smock Fenster 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 appfiratian for Payment has been completed in accordance with tho 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 $ 331,500.00 2.Net change by Change Orders $ 0.00 CONTRACTOR: Smock Mil �t 3.CONTRACT SUM TO DATE(Line 1 + i', 2) $ 331,500.00 ,e 4.TOTAL COMPLETED AND STORED TO DATE $ 312,650.00 By: i _ Vu O 06 O '77 r. T.M.FANSLER / r055 2 / c• 5.RETAINAGE State of.IN r a. 10.00%of Completed Work $ 31265.00 • County of MORGAN b. 0.00%of Stored Material 5 0.00 Subscribed and Sworn to bet 2/1°614 ,07 Notary Public: „in. �� �� Total retainage(Line 5a+5b) $ 31 265.00 r/._e_L.. My Commission Expires: I 6.TOTAL EARNED LESS RETAINAGE $ 281,385.00 ARCHITECT'S CI N� / )O�� (Line 4 less Line 5 Total) I Accordance with the Conti Ac 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In i 263,330.32 prising the above application' (Line 6 from prior Certificate) $ knowledge,information and 1 8.CURRENT PAYMENT DUE $ 18,054.68 is in accordance with the Co; AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Line 3 less Line 6) S 50,115.00 AMOUNT CERTIFIED a (Attach explanation if amount cart;-.differs from the amount applied.Initial o0 figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on L Sheet that are changed to conform to the amount certified.) Total changes approved In ARCHITECT: previous months by Owner 0.00 0.00 By: +,, t. , k Date: q/14 11 -- 1 Total approved this Month _J 0.00_ 0.00 named herein.Issuance,Paybment and acccep acceptance of pa CERTIFIED w re without prejudice to any atja,TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 0.00 / 07,„ arc. -�� 9)?a 1 11 ALA Type Document Application and Certification for Payment Page 2 cf 2 TO(OWNER):VILLAGE FINANCIAL LLC PROJECT:HANOVER SQ FOUNT @ CITY CTR. APPLICATION NO:5 DISTRIBUTION 770 3RD AVENUE SW 770 3RD AVENUE SW TO: CARMEL,IN 46032 CARMEL.IN 46032 PERIOD TO:9/30/2011 _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 ern—_ BALANCE RETAINAGE 1 FOUNTAIN EQUIPMENT 181,785.00 181.785.00 0.00 0.00 181,785.00 100.00 0.00 18,178.50 2 PIPING/PUMP 71,215.00 67,654.25 3,560.75 0.00 71,215.00 100.00 0.00 7,121.50 INSTALLATIONIELEC 3 GARAGE IMPROVEMENTS 23,500.00 21,150.00 0.00 000 21,150.00 90.00 2,350.00 2,115.00 4 PAVING AND SURFACE 55,000.00 22,000.00 16,500.00 0.00 38,500.00 70.00 16,500.00 3,850.00 EQUIPMENT REPORT TOTALS 8331,500.00 $292,589.25 520,060.75 $0.00 $312,650.00 94.31 $18,850.00 831,265.00 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: Village Financial LLC to furnish certain labor, materials, and/or services as follows: Misc. Construction for a project known as: SF0l11-023 Hanover Sq. Fountain (ii) Clay Or. 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 (518,054.68) Eighteen Thousand Fifty Four Dollars and 68/100 [ ] receipt of which is hereby acknowledged;or [X] the payment of which has been promised as the sole confideration 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 affective upon receipt of stch 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. qqj�,,rte SMOCK FANSLF,R CORP. By V',/�• �"/'`Af/�'✓ Title CEO T.M.Fansler WITNESS MY HAND AND NOTARIAL SEAL,this 201h day of September,2011. �ARV 5 y �Q•... < z% •1 Melissa J.Bishop Notaryitublic at../-1 • My commission expires November 30, 2016 Residing in Morgan County F 4 Grid/O\PS At~ w.t e:J:il!yalCad