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<br />•;i':.-APPLICAWN AND CERTIFICA E FOR PAYMENT AIA DOCUMENT G702 PAS.
<br />TO (Owner): BOARD OF COUNTY, COMMISSIONERS PROIECT:INDIAN RIVER COUNTY APPLICATION NO:- 17 D�s:ribution to
<br />..INDIAN RIVER COUNTY, FLORIDA COUNTY COURTHOUSE BUILDING r OWNER,°. ,
<br />1840 25TH STREET ADDITIONS &RENOVATIONS PERIOD FROM: 1/10/82 =ARCHITECT z '
<br />{ `" 11VER0 BEACH, FLA. 32960 8020 TO: 3/25/82
<br />: I L CONTRACTOR
<br />r . : ARCHITECT'S CONSTRUCTION CONNELL, METCALF &EDDY CONTRACT FPROJECT NO'9364P.O. BOX 341939
<br />CORAL GABLES, FLORIDA 33134'
<br />ATTENTION: MR. F. KIRSCH CONTRACT DATE: APRIL 2, 19-3
<br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connecti.c'7, with the Contract
<br />Continuation Sheet, AIA Document G703, is attached. >w:�
<br />M ..
<br />CHANGE ORDER SUMMARY
<br />'
<br />Change Orders approved
<br />in previous- months by
<br />Owner..,--:-* ,..
<br />' TOTAL
<br />ADDITIONS
<br />169,022.59
<br />DEDUCTIONS
<br />1,856.20
<br />Approved this Month
<br />t.
<br />•
<br />Number
<br />Date Approved
<br />TOTALS .169,022.591
<br />1,856.20
<br />Net change by Change Orders
<br />1 167,166
<br />The present status of the account for this Contract is as follows:
<br />ORIGINAL CONTRACT SUM . ................ $ 6&9,000.00
<br />1234 6Net change by Change Orders ...................... $ 167 ,166.39
<br />CONTRACT SUM TO DATE ........................ $_855,166.39
<br />�c
<br />•,f: i 856,166.39
<br />a�Q•,� a� TOTAL COMPLETED & STORED TO DATE ........... $
<br />(Column G on G703)
<br />1,000.00
<br />RETAINAGE
<br />• or total in Column I on G703
<br />TOTAL EARNED LESS RETAINAGE , , , , , , , , , . $ 866 166.39
<br />The undersigned Contractor certifies that to the best of his knowledge LESS PREVIOUS CERTIFICATES� FOR PAYA"ENT . $
<br />information and -belief. the Work covered by.this Application for /i 6< 3% / ��
<br />ZA , 9�.�
<br />Pay ent has been completed in accordance with the Contract Docu ./ (p 9r. OG "
<br />men ►amounts have been paid by him for Work for which , '� X ,y� -• i' �y Q}��043 '}�
<br />pre%ii ertifcates for Payment were issued and payments received CURRENT PAYMENT DUE
<br />from a Owner, and that current pay nt sh m herei is now due
<br />C TRACTOR: REIN CTI INC '' State of: FLORIDA Countyofi•'•''B'RE- 1ARD
<br />Subscribed and swo o be ore me t is 2WOZARCH,jy82Notary Public:•
<br />By: ufl,pate: My Commission expires: :.,• a
<br />.. u _ ea.i .. i Flnrida at a /.
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT Commission Ex ues May ca
<br />-
<br />AMOUNT CERTIFIED Y. p $
<br />nd d T6ri,•TroV*Wd-Wuranea•1na• „
<br />(Attach explanation if amount-certi er�differs Irort>;t. amodn�-app�i@� G1J b^
<br />In accordance with the Contract Documents, based on on-site obser !r -�.'u ,V , • ,
<br />ARCHITE
<br />nations and the data comprising the above application, the Architect �`��?'•'•., .,�"
<br />certifies to the Owner that the 1M1ork has progressed to the point
<br />indicated; that to the best of his knowledge, information and belief, By.
<br />the quality of the Work is ,n accordance with the Contract Docu- I
<br />mems; and that the Contractor is entitled -to payment of the AMOUNT This Ce ,ficate t negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
<br />CERTIFIED. named herein. suance, payment and -acceptance of payment ale v..t nout prejudice to ani
<br />rights of the Owner or Contractor under this Contract.
<br />AIA DOCUMENT 0702 • APPLICATION AND CERTIFICATE FOR PAYMENT • APRIL 1978 EDITION • AIAQ • © 1978
<br />THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVENUE, N,W., WASHINGTON, D.C. 26006,6702-1978
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