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APPLICATION AND CERTIFICATE FOR PAYMENT MA DOCUMENT G702 { , nStiUClIUn :. r >, •. tIcIr iml 3
<br /> It r r ]\ rt if Ir INDIAN RIVER COUNTY lips , 11 t I OSLO CONVENIENCE CENTER APt'L1CA1 106N ,aft
<br />10 1
<br /> 1325 74TH AVENUE SW
<br /> VrRO BEACH, FL 32962 PERIOD 10 10/8/2013 )'K ( t�ts ;r1 G
<br /> Pf( OIEC( NO.`, 120- 14 I ,t ARU illl F ( - I
<br /> 1 ref r.1 (, r , t , r1tnC t r , h PAUL JAC UIN $ SONS. INC . I ! (
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<br /> Q 1 :�. .u , ( 11 , = i t 1 CONTRACT I >AI r
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<br /> P. O. BOX 4343 I
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<br /> FORT PIERCE, FL 3494S !
<br /> art ! 1 FA Al 1 fl ) I?
<br /> The undersigned Contractor certifies That to Itte' L.c^•I t : l IIIr ( t Inn At :.
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<br /> CONTRACTORS APPLICATION FOR PAY AM ENT ma ( ton and brlic ( the �Y%ork covered by fills Apph a , lun It • , I ., ,eine
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<br /> r'. p1 ;Ilk Jl p . n r. ,naris tVr p:,ymr- nl , :1% •: hr, tvn brls r,v n '; , t , , , nt• c t , r . rt tt• n r,
<br /> , lir t , . nIt . rel in accordance with the Conlrici DoC , tn, ecw. lh :u all 7 , tit nnv :. h .,vr Isr• rn lk :110
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<br /> rnt , nMOM t , n }. I , CC1 , AIA Drietin,cnl ( 17fr4*j . . :, u . , t [ its : Contractor for Work for which
<br /> previous Cc' ll , l , i .ur •, Itis r '.IYn ,cm evt' t (• n � , : rtJ .uttl hac
<br /> 1 ORIGINAL CONTRACT SUP.1 I , 161 ,000.00 merits recrrvrd from the Owner, and 11131 cutivii , I �avn , rnr
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<br /> Nel change by Change Orders t -5431277.96 C. OJTRACTOR PAUL JACQUIN JC SONS, INC .
<br /> CONTRACT SUMTO DATE ( l. ntc I s } 1 ,617 ,722-04 Uy
<br /> - - /ILL - - I ]. 11 t 10/ 31 / 13 - -
<br /> TOTAL COMPLETED 8t STORED TO DACE 1 ,617 ,722 .04 Starr of FLORIDA
<br /> ft _ oltnr, , , G (, n Cru ', ) - - - County of ST. LUCIE
<br /> RETAINAGE : Suhsertbcd and Sworn to before
<br /> - - - - - I _ _ . . _ 3131 day Of OCtOh2I' 201151
<br /> •7 � n`� Notary PUCI1c S
<br /> tate of Florida
<br /> %. nl ( . tint ]Icu_ ( 1 Wn11•. t rite' thlti a� N1chOIC Kra
<br /> ( f u ! ulnn•. D r L' on C In ?, j �S_• My C;ArmisslE054615nr ;, Ift , CCl
<br />b, alt: nal 6 oil,o Exp,res01 /115
<br /> tCnlnrl if F off GIGS ) Notary Public .
<br /> Real Rr_• I :unayc ( Ln',r- Sa 511 t „ - 0.00 NI 1 Convnlssion expires . / / -
<br />- - -- —
<br /> It ,1al u', (;,olunu , I of GJt) i ) :
<br /> 6 TOTAL EARNED LESS RETAINAGE s
<br /> 1 ,617 ,722 .04 ARCHITECTS CERTIFICATE FOR PAYMENT
<br /> { I it ! (- :1 Ir• •,�, I - Ins r) Tr)lal )
<br /> i LESS PREVIOUS CERTIFICATES FOR PAYMENT 1 ,515 ,345 ?9 In accordance with the Contract Documenis, bascet on on :, etc
<br /> oh:,c• r vat Tor, :, :) , 1c1 I lie 1 (313
<br /> Il n , c 6 ftru » 1)PIIof Ccr1 , Gcalf: ) s _ — c• Olnprlsing this application , the Archdcci ccrllhcs
<br /> it ) 111 (• Owllrr Thal Ili tilt' heti ( of lilt
<br /> - - - Architect 's knowledge, information and belief tile• CC'utk 11 :, 7. , ot, le •••.c < f
<br /> a :, nultral ( f • the
<br /> 102:376:75 1 t • - - r
<br /> t : C (1RRF_ tdT PAVPdFN '( DUE (- R _ � qualify Of the \tiOfk is in accordance wuh Thr Ct, nuact
<br /> 1 )nrnnu• nl : , antl Thr ( ' s , n , , ;,cln ,
<br /> - Is cnnlicd to pavment of d, c AMOUNT Cla'"111' IrI )
<br /> 9 BALANCE TO FINISH , INCLUDING RETAINAGE 0 /
<br /> c . . Linc 0) I _ i _ - ' 00 AMOUNT CERTIFIED . .
<br /> — (11ficlb explolmtto]1 rf amoral eerlrfted dr/furs poor, tilt• rtrnurrrr, f1ppltt•ct fur
<br /> Cllr\ rd (;, ( C) RD � tt SIIi.1t� lAR %_I nUUI lIOrJ ', Olt frSUIVS Ort This Applicnitorr tend Ow tfw
<br />(:u] tr ] ] ] ]rur20)) $!t. •r•! ! ! rn ! rise Cl,r+ nr .c•rt 10
<br /> 1s ,r ,, l ch : nt;cs :, pp , ovr (l rn IfI! 70,796.95 ! 6139327 . 37 co ] rjorm rn rbe� r�rlSerltjred. )
<br /> p , cv ,ou:. n,os,lhs by Owenct
<br /> l?i, .rl al>I , rovttl 111 ,:. Month - - - - — - -747 By . 0 , 1c l
<br /> _ TOTALS - _70 ;796.95 — -614,074:91- This Certificate is no 1 . Ie, The AMOUNT- CE1(•L11: IG1) , :. payable•
<br /> only to 111e Coll .NET CIIANGES by Change Orcler =54"77:96 ( r3ctor named h in . Issu3nee• payment
<br /> and arceplance o1 paymcm ate without
<br /> -- - preiudiec to any rights of the Owncr of Contractor uneicr lilts Conu :lcl
<br /> AIA DOCULIE- 111 G702 - APPLICAl , ON ANO rrItTli ICATF, rOJt PAY,%.IEN1 - irw Enl riots - AIA"' • 01992 THE
<br /> Arl [ R1CAN INSTITUTE OF ARCHITECTti, 1735 NF �V 1'01: 1:
<br /> .` l , �• AVCNUE• Nty \lA:I ❑NGTON. u (' 2o, N,(� S:•I [ - WARNING; llnbct•nr.4t1 phn,ocopynxt v,olales U. S. copyright l,�rrs
<br /> and wilt subject The violator 10 legal proseorlion 13702_1992
<br /> CAU 1ION : Ynu 'D hl use an original AIA dor. urnenl vrhn h hr: this r :, ulnm p , illlvd in serf . An nriginal :,sures that changes
<br /> will not be obscured : r.: n ,nv ot: Cur w1t, . n Jr,t• , onr. .,, .-
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