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HomeMy WebLinkAboutSMOCK FANSLER CORPORATION- 001298- 10/21/2010 ' CARMEL REDEVELOPMENT COMMISSION 001298 Smock Fansler Corporation Check: 1298 2910 W Minnesota Street Date: 10/21/2010 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2918 14,505.48 14,505.48 0.00 0.00 14,505.48 P111 pavers 14,505.48 14,505.48 0.00 0.00 14,505.48 alt Carmel Redevelopment Commission sREGIONS /001.29.8 aS0 West Main Street Suite 220 xo-iazvrao \STR�ARM[CL Carmel, IN 46032 , • 1298 DATE AMOUNT 10/21/2010 "'""'•"14,505.48 PAY THE SUM OF FOURTEEN THOUSAND FIVE HUNDRED FIVE DOLLARS AND 48 CENTS TO THE ORDER OF • - Smock Fansler Corporation 2910 W Minnesota Street <`S`"'°m ' . Indianapolis, IN 46241-4541 ""'00 1 29811' 2 1 3 1:1:071,0L4 008 7 504 1 l ili' CARMEL REDEVELOPMENT COMMISSION 001298 Smock Fansler Corporation Check: 1298 2910 W Minnesota Street Date: 10/21/2010 Indianapolis, IN 46241-4541 Vendor: SMOCKFA1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt, Paid 2918 14,505.48 14,505.48 0.00 0.00 14,505.4E P111 pavers 14,505.48 14,505.48 0.00- 0.00 14,505.4E • iaz> REQUEST FOR PAYMENT From: Smock Fenster Corporation To: CARMEL REDEVELOPMENT COMMISSION Invoice: 2918 2910 W. Minnesota Street 30 W.MAIN ST. Draw: APP00001 Indianapolis, IN 48241-4541 CARMEL,IN 48032 Invoice date: 8/20/2010 Period ending date: 8/312010 Contract For. Request for payment: Original contract amount $805,860.00 Approved changes $0.00 Project: 10081 Revised contract amount $805,860.00 P, 111 PAVERS Contract completed to date $18,117.20 Contract date: Add-ons to date $0.00 Taxes to date $0.00 Archite Less retainage ti'tainage $1,811.72 Total completed less retainage $14,505.48 Scop Less previous requests $0.00 Current request for payment $14,505.48 Current billing $18.117.20 Current additional charges $0.00 Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Less current retainage $1,811.72 Changes approved in previous Current amount due $14,505.48 months by Owner Total approved this Month Remaining contract to bill $791,354.52 TOTALS NET CHANGES by Change Order 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 e Contract(and all authorized changes thereof)between the undersigned and the CARMEL REDEVELOPMENT COMMISSION relating to the above referenced project. I also , PRY PVe(/ e certify that the contractor has paid all amounts previously billed end paid by the owner. �'. ., Q CONTRACTOR: mode Fenster Corporation State Of INDIANA County Of MORGAN —-- . By: ear-« Subscribed and sworn to before me this Z �dayyJof, .911, -. ale (: SEAL . Dat %"4d'-1D Notary Public i��CtLGO6t�{/.^V(///L0 I J My commission expires: 1// 1/41/4 / 0417-E hr" COAnUczcoa) MwwCf ; �nyr/t° r r��mm tND CSo A(tct11'f2C-T5: $ 14. t,ps,st I .CS ._ S1;oItd Director of Redevelopment �'f'4C0865 REQUEST FOR PAYMENT DETAIL Project: 10081/P.111 PAVERS Invoice: 2918 Draw:APP00001 Period Ending Date: 8/3112010 Detail Page 2 or 2 Payer Item ID Description Total Previously Work Presently Completed 55 Balance Retelnage Contract Completed Completed Stored And Stored Comp To Balance Amount Work This Materials To Date Finish Period I r 01 MOBILIZATION 10,000.00 200.00 200.00 220 9,800.00 20.00 02 FIELD ENGINEERING 10,00000 200.00 200.00 2,00 8,800.00 20.00 03 ASPHALT BASE 185,400,00 3,308.00 3,308.00 2,00 182,092.00 330.80 D4 UNIT PAVERS 820,480.00 12,400.20 12.40920 2,00 808,050.80 1,240,92 Totals 805,884.0D1 i 16.117,20 18,117.201 2.00 789,742.80 1,811.72 AFFIDAVIT AND WAIVER.OF LIEN L l Final [X]Partial PC]Payment to Follow State of Indiana County of Marion Jerry 14 Dane , being duly sworn states that he is the Executive Vice-President of SMOCK FANSLER CORP. having contracted with: Carmel Redevelopment Commission to furnish certain labor,materials,and/or services as follows: Misc. Construction on behalf for a project aforementioned t known SF ator. 111 Pavers located at Carmel.IPi and does hereby (PARTIAL WAIVER)that there is due from the owner the sum of:MAMA), Fourteen Thousand Five Hand red Five Dollars and 48/I L ] receipt of which is hereby acknowledged;or [X] the payment of which has been promised as the sole combination 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( ,) J 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 stet'payment THEREFORE, the undersigned waives and releases unto the Owner of said premises,any and all Om or claim whatsoever on the above-described proper and improvements thereon on account of Labor, Materials, and/or Services, furnished by the undersigned thereto, subject]e ytelahni limitations US oconditions latio s expressed herein, if any; and further certifies that no other party account of any work performed, materials, or services furnished to the undersigned for said project, and within the scope of this affidavit and waiver. F„e , ive Yiee t11 By Title 1 11 SMOCKFANSLEN CORP. y Jerry M.DaYee a&ru,,,,, m st 2010. WITNESS MY HAND AND NOTARIAL SEAL,this 2Q_day of r Melissa J.$isho Notary lie : SEAL • ,,� `v Residing in County rcQP K �s My commission expires November"t0.20i -------1 OP ID: LB AOC:PR I" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIeDNYYYi 11/29/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies( must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER 317-849-8800 M°me Cl H.J. Spier Co., Inc. H. J.Spier Company, Inc. 317-576-5058 PHONE .317-849-8800 IFax 5750 Castle Creek Pkwy.,#150 E-MAIip,.Exq. FAX No): 317-576-5058 Indianapolis,IN 46250-4359 PRODUCER James G. Null - CUSTOMER ID E.SMOCK-1 INSURER(S)AFFORDING COVERAGE NAIC k INSURED Smock Fansler Corporation INSURER A Selective Insurance Co 39926 Attn: Dia Donoho INSURERe:Accident Fund Ins. Co. 10166 2910 West Minnesota Street Indianapolis,IN 462414541 INSURER C: INSURER D: INSURER E INSURER F: COVERAGES - CERTIFICATE NUMBER: REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE EC2 TFIE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY DE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF AODL SUER POLICY EFF POLICY EXP LTR INSRI WVO POLICY NUMBER IMMIDDIYYYYI IMMIDONTYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A X COMMLRCbLL GENERAL LIAUII.ITY X 51731000 05108110 05/08111 DAIdATiETORENT�p 100,000 PREMISES I§gpccunence) $ _ _ CLAIMS-MADE X OCCUR MED EXP/Any one person]. $ 6,000 GENERAL AGG PER PROJ PERSONALSADVINJURY $ 1,000,000 BROAD FORM CONTRACT GENERAL AGGREGATE 5 2,000,000 GFI FI II N'L AGGREGATE LIMI I'APPLIES PER' PRODUCTS-COME/DP AGO 1 2,000,000 POLICY X j7Er° n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ' 1,000,000 A X ANY AUTO 51731000 05/05/10 05108/11 ten zocldenq BODILY INJURY/Per person) 5 ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE 1 X HIRED AUTOS (Pei accideni) 1 X NON-OWNED AUTOS S 5 UMBRELLA LIAR X OCCUR EACH OCCURRENCE 5 9,000,000 EXCESS LAB CLAIMS-MADE AGGREGA(IE $ 9,000,000 A — S1731000 05108!10 05/08111 LEDUCTIELE $ I X 'RETENTION $ 10,000 --___-_I s WORKERS COMPENSATION X ITVA LI MITS' X F AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y N 'WCV6008014 05100110 05106/11 E.I.,EACH ACCIDENT $ 500,00 OEEICERAMEMOER EXCLUDED? N1A (Mandatory in NH) (IN, MI) C.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below t EL.DISEASE-POLICY LIMIT $ 500,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach A-CORD 101.Additional Romarks Schedule,if more space is required) Re:Carmel City Center Motor Court 8 Fountains;SEC 410-140 City of Cannel, Carmel Redevelopment Commissions and Pedcor Design Group are included as Additional Insureds as respects the General Liability. CERTIFICATE HOLDER CANCELLATION CARMEL SHOULD ANY 01 THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carmel THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS, One Civic Square Carmel„ IN 46032 AUTHORIZED REPRESENTATIVE a\-1".6'62 0, \ U.-P e I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109( The ACORD name and logo are registered marks of ACORD