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, APPiCCATiON AND CERTC GCATL Fon PAYMENT 40. 9 07 AIA DOCUMENT G702 PAG: ONE OF 32 PAGES TO (Owner): BOARD OF COUNTY COMMISSIONERS INDIAN RIVER COUNTY, FLORIDA 1840 25TH STREET VERO BEACH, FLORIDA 32960 ATTENTION: CONNELL, METCALF & EDDY P.Q. BOX 341939 CORAL GABLES, FLORIDA 33134 PROJECT: 8010 INDIAN RIVER COUNTY ADMINISTRATION BUILDING ADDITIONS & RENOVATIONS • CONTRACT FOR: CONSTRUCTION CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY Change Orders approved in previous months by Owner TOTAL ADDITIONS 497,907.74 DEDUCTIONS (178.95) Approved this Month 40,800.18 i ... Numbbr Date Approved ADDITIONAL APPROV. TOTALS • 538,707,92 (178.95) Net change by Change Orders 538, 528.97 APPLICATION NO: 21 Distribution to: 0 OWNER 12/10/81 0 ARCHITECT 12/31/81 ❑ CONTRACTOR PERIOD FROM: ; TO: ARCHITECT'S PROJECT NO: 9363 0 ❑ • CONTRACT DATE: APRIL 2, 1980 Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. ;.The present status of the account for this Contract is as follows: ORIGINAL CONTRACT SUM $ 2,748,000.00 Net change by Change Orders $ 538, 528, 97 CONTRACT SUM TO DATE $ 3,286,528,97 TOTAL COMPLETED & STORED TO DATE$ 3,286,528.97 (Column G on G703) ETAINAGE •o • as• 0- ii a . The undersigned Contractor certifies that to the best of his knowledge, information and belief the Work covered by this Application for • • Payment has been completed 'in accordance with the Contract Docu ment., previous C from th I amounts have been paid by him for Work for which cates for Payment were issued and payments received wner, and that current paymen shown herein is now due. CON CTOR: REINHOLD, INC By: cu or total in Column I on G703• t `z TOTAL EARNED LESS RETAINAGE r' —3;281;528.97— —15,000.00: $ Lq, 12/30/81 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site obser- vations and the data comprising the above application, the Architect certifies to the. Owner that the Work has progressed to the point indicated; that to the best of his knowledge, information and belief, the quality of the Work is in accordance with the Contract Docu- ments; and that the Contractor is entitled to payment of the AMOUNT CERTIFIED. •• LESS PREVIOUS CERTIFICATES FOR PAYMENT 2,879,975.08 LESS PAYMENTIN PROGRESS' -33,348:12_ CURRENT PAYMENT DUE $ :368,205 .77 State of: FLORIDA Subscribed and sworn to Notary Public: My Commission exp me this ubl� iat--ef-EloridA rrt Incr. County of: BREVARD f DEC. ,19 *AMOUNT CERTIFIED My ommission Expires May 3,19V, •(Attach explanation if amount cer BfreaddiPfersr°from the amount applied tor.) ARCHITE r y �+ By: L) ' Date: 1 Gq e'�7 This Certifica a is not nI.tiab The AMOUNT CERTIFIED is payabl only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • APRIL 1978 EDITION • AIA` • © 1978 THE AMrRICAN INSTITUTE OF ARCHITECTS. 1735 'NEW YORK AVENUE, N.W.;' WASHINGTON, D.C. 20006';