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Home My WebLink AboutSMOCK FANSLER CORPORATION- 5- 11/30/2011 Smock Fansler Corporation Check: 5 P 2910 W Minnesota Street Date: 11/30/2011 Indianapolis, IN 4624 1=4 541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 6 Hanover Square 100 17,280.00 17,280.00 1,728.00 0.00 15,552.00 Hanover Square (IPC - Merc) 17,280.00 17,280.00 1,728.00 0.00 15,552.00 5 11/30/2011 """""""`""15,552.00 THE SUM OF FIFTEEN THOUSAND FIVE HUNDRED FIFTY TWO DOLLARS AND NO CENTS ******" Smock Fansler Corporation 2910 W Minnesota Street Indianapolis, IN 46241-4541 Smock Fansler Corporation Check: 5 2910 W Minnesota Street Date: 11/30/2011 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 6 Hanover Square 100 17,280.00 17,280.00 1,728.00 0.00 15,552.00 Hanover Square (IPC - Merc) 17,230.00 17,280.00 1,728.00 0.00 15,552.00 AlA Type Document vie/is-3 9 Application and Certification for Payment Page 1 of 2 TO(OWNER):VILLAGE FINANCIAL ILC PROJECT:HANOVER SO FOUNT a CITY CTR. APPLICATION NO:6 Jr�ro DISTRIBUTOR 770 3RD AVENUE SW 770 3R0 AVENUE SW TO: CARMEL,IN 46032 - CARMEL,IN 45032 PERIOD Tp:30fl1I2011 _OWNER _ARCHITECT _CONTRACTOR FROM(CONTRACTOR):Smock Fenster Corporation VIA(ARCHITECT): ARCHITECT'S 2910W.Minnesote Street PROJECT NO: Indianapolis,IN 46241 • CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor canines that to the best of theContractors 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 ContraG. Contract Documents,that at amounts have been paid by the Contractor for Work for which previous Continuation Sheet.AIA Type Document is aftactrad. Certificates for Payment were issued and payments received from the owner,and that current payment shown herein is now due_ 1.ORIGINAL CONTRACT SUM $ 321,50000 2.Net Change by Change Orders E 000 CONTRACTOR:I - - _ 3.CONTRACT SUM TO DATE(Line 1 +2) $ 331,500.00 f III /j f 6,TOTAL COMPLETED AND STORED TO DATE... .. , S 329,930,00 By: ��`/' ( /O!`s ( ! 2?O •0� 'r�' °_.r '' 5, RETAINAGEC T.M.FANS a. 10.00%of Completed Work state of:IN pp CJO A E 32,993.00 I r 7z 0 - tNt)\r` - County of: MOR l b. 0.00%of Stored Material S 0.00 Subscfied and n 6yt ii p�j Total retalnage(Line 5a+Sb} $ 32,993.00 Notary Public' ill /L/ r�' SS2 My COmmissitr1 8.TOTAL EARNED LESS RETAINAGE $ 296,937 00 I ' (Line 4 less Line 5 Total) ARCHITI 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance] e data corn- (Line 5 from prior Certificate) 5 281,385,00 prising the abut Architect's knawiedge,infc of the work 6.CURRENT PAYMENT DUE ... E 15,552.00 is in accordant: yment of the 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERIt II4 ftane 3 less Line 6) $ 34,583,00 AMOUNT CERTIFIED 5--r>755—e,Cp CHANGE ORDER SUMMARY ADDET10H5 DEDUCTIONS (Attach explanation if ernowd certified diners Iron the amount applied. trmial all figures an This Application and on the Continu- an Sheet That are charged to oonfpan to the amount codi8cd) Total changes approved M ARCHITECT: previous months by Owner 0.0(1 0,00 C. Br. � Data: 14/asfih rr ti - Total approved this Month 0.00 0.00 This Genitals is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,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 7- • 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: SFC#11-023 Hanover So. Fountain Clay Ctn 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: ($15.552.00) Fifteen Thousand Five Hundred Fifty Two Dollars and No/100 [ ) receipt of which is hereby acknowledged;or [X) the payment of which has been promised as tie 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(SO.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 hen 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 [imitations 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. q SMOCICFANSLERCORP. By ektptle CFO T.M.Fansier WITNESS MY HAND AND NOTARIAL SEAL,this 19`" day of October,2011. ' ar v PL/at/cad ' ![ <7. ✓/ fir: n Melissa J. Bishop Not Public y� " � My commission expires November 30, 2016 Residing in Morgan County ":. »E =}ra.!.)tr • f 51ate of INDIANA Cnunry of MORGAN .-. Subscribed and sworn to before me, a Notary Public in and for said County and Slate. this 79th day of October 2011. t rr'• r.� �i (Notary Public" My Commission Expires: November 30.20115 Melissa.1. Bishop (Print Name) Attachment A TRANSFER OF TITLE Smock Fansler Corporation (Contractor) transfers to Village Financial, LLC any and all right. title and/or interest that Contractor has in any labor and/or materials described in (i) that Affidavit of Waiver of Lien executed by the Contractor on October 19th , 2011, and (ii) in the "Amount of this Request" section of that "CONTRACTOR" By: c://21-2 Printed; T.M. Fansler Titles CEO