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Attachment F: AIA Forin 670 <br /> Continuation Sheet AIA DOCUMENT G703 (Instructions on reverse side) Page 2 of 2 Pages <br /> AIA Document G702 , APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: FINAL <br /> Contractors. signed Certification is attached . APPLICATION DATE : 1111412012 <br /> In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/ 3112012 <br /> Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: IRC BID2032027 SCRO <br /> A 8 C D E F G H ! <br /> WORK COMPLETE' <br /> ITEM DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS THIS PERIOD MATERIALS PRESENTLY TOTAL COMPLETED AND BALANCE TO RETAINAGE <br /> 55% <br /> NO. APPLICATION (D+E) STORED (NOT IN D OR E) STORED TO DATE (D+E+ F1 `c(G+C ) FINISH IC •G) <br /> 1 generator install 539,288. 70 S39,288. 70 $0400 $ 39,28830 100% $0.00 $1 , 964. 44 <br /> 2 change order #1 $21 , 358. 54 $21 , 358. 54 $0000 $21 , 358. 54 1 W $0. 00 $ 1 , 067. <br />93 <br /> 3 change order #2 $ 1 ,700.00 Si , 700.00 $ 11700,00 100% $0.00 $85 . 00 <br /> 4 change order #3 $4, 143. 75 $41143. 75 $4, 143. 75 100% $0.00 $207. 19 <br /> TOTAL ALL PAGES $66,490.99 S60164T24 55,843 . 75 50.00 $66 , 490.99 100 50 .00 1 $31324. <br />55 <br /> AtA DM..UMtNT 0.-703 APPLICATION AND CERTIFICATE FOR PAYMENT AkAY 1483 EiNPON • Aa REGISTERED • COPYRIGHT 1983 <br /> TNF_ AAiERt:APj it15TtT-iiTE or 4Rt.NITEt?5; 1735 VIEW ±ORK AVERUEs tI-W, o WASHMGTOW D.t. 10006 . <br /> AIA Forn16703 <br /> 4 <br />