02/19/2013AP - Laserfiche WebLink

Home Browse Search

ti APPLICATION AND CERTIFICATION FOR PAYMENT AUDOCUA=G702 PAGE ONE OF TWO PAGES TO OWNER:GO PROJECT:INDIAN RTVER COUNTY SWDD APPLICATION NO: 3 Distribution to: INDIAN RIVER COUNTY CUSTOMER CONVENIENCE CENTER .at OWNER 1801 27THSTREET APP.DATE: 2/82013 ®ARCHITECT VERO BEACH,FL 32960 PERIOD TO: FINAL&RETAINAGE 0 CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: PO N0: 2012047 Mancil's Tractor Service,Inc. EJ 4551 SE Hampton Court CONTRACT DATE: 8/312012 Stuart,Florida 34997 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned CDntmcto.r certifies that to the best of the Contractors L-nowlcdgc, Application is mads for,payment,as shown blow,in connection with the Contract. informatiommnd bcliefthe Woticcovered.by this-Application for Payment.has been Continuation Sheet;AIA Document G703,is attached. completed in accordance with the Contract-Documents,that all amounts have been paid by the Contractor for Work:for tvhich:previous Certificates.for Payment were issued and payments received from the Owncr,and that current payment shown herein is now due. L ORIGINAL CONTRACT SUM $ 141,892.50 2 NET CHANGE BY CHANGE ORDERS $ 12;500.00 CONTRACTOR Mancil's T or Scrvicc;Inc. 3. CONTRACT SUM-TO DATE(Line 14:2) $ 154,392.50 % 4. TOTAL COMPLETED d:STORED TO $ 154392.50 / DATE (Column G on G703) By ! —(�( M Smith Date:Fcbnmry 8.2013 5. RETAINAGE: Who is persjdswojn- lly kao to me. a 10 %of Completed Work $ 0.00 State off Pio 7 County of Martin re`°.' -'Let% WANDA SUE SMART (Column p+E on G703) Subscribed to before m is dayof Febnrmy,2013. 14YCOMh{fSSION:S DD 9676TT 6. 10 %of StoredMatcrinl $ Notary Public (� �r r'n_ * * EXPIRES:April 25 2014 (ColumnFonG703) ty2ecp My'Commissionexpirs: 4/25/2014 I��rFOFFto'` Banded Thal BudgetNalaryServices Total Rctainage(Lines 5a+5b or Total in Column IofG703) $ 0.00 -A..^_ T-E=-T3S"CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 154.392.50 In accordance with the Contraet,Documents;:based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application;.the Architect certifies:to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR z°aefiiteel' latowledgei information and belief the Work has progressed as indicated, PAYMENT(Linc 6 from prior Certificate) $ 127,703.25 the quality of the Work is in accordance with the Contract Documents,and the Contractor S. CURRENT PAYMENT DUE $ 26.68925 is entitled to payment of the AMOUNT CERTIFIED. 11 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 0.00 (Line 3 less Line 6) JJr s AMOUNT CERTIFIED...........$ CHANGE ORDER SUMMARY ADDITIONS Dl DUCIYON5 (Atiadr explanation ifamormt—017ed differsfrom the amount applied Initial all fegtres on chis Total changes approved Applicationo in previous months b Owner ontlre Continuation Sheet that are changed to conform with the amount certified,) $12,500.00 $0.00 - s Total approved this Month $0.00 50.00 By. 1 Date: TOTALS $12,500.00 50.00 This Certificate is not negotiable-- The AMOU TIFLED is payable only t'o the nce, ` Contractor named herein.issuapayment and acceptance or payment are without NET CHANGES by Change Order. $12,500.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT C702-APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDITION-AU-01092 THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVE_N.W-WASHINGTON.OC 20006.5292