Laserfiche WebLink
APPLICATION AND CERTIFICATION FOR PAYMENT <br />AM DOCUMENTG902 PAGE 1 OF 3 PAGES <br />TO OWNER: Indian River County <br />PROJECT: Central Regional WWTFHeadwc APPLICATION NO: FINAL Distribution to: <br />1800 27th St <br />OWNER <br />Vero Beach, FL 32960 <br />TV T <br />RECE <br />ARdMCT <br />FROM CONTRACTOR: <br />7VOCA(mTZ�3�. <br />PERIOD TO: April 3, 2017 CONTRACTOR <br />E & D Contracting Services, Inc. <br />Mark Piper <br />2001 Mills B. Lane Blvd. <br />BY:PROJECT <br />NOS: 2016023 <br />Savannah, CYA 31405 <br />CONTRACT DATE:- <br />ATE:CONTRACTOR`S <br />CONTRACTOR'SAPPLICATION FOR PAYMENT <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge; <br />Application is made for payment, as shown below, in connection with the ContmcL <br />information and belief the Work covered by this Application for Payment has been <br />Continuation Sheet, AIA Document 0703, is attached <br />completed in accordance with the Contract Documents, that all amounts have been paid by <br />the Contractor for Work for which previous Certificates. for Payment were issued and <br />payments received from the Owner, and that current payment shown herein is now due. <br />1. ORIGINAL CONTRACT SUM <br />$ 350,656.00 <br />1 <br />2. Net change by Change Orders <br />$ <br />CONTRACTOR. E &tD Contracting.Services, Inc. <br />3. CONTRACT SUM TO DATE (Line I t 2) <br />$ 350,656.00 <br />// <br />4. TOTAL. C&PLE IED & SPORED TO DATE <br />$ $322.656.00 <br />0�9f� t! -i <br />By: Date: /, i <br />(Column G on 0703) <br />5. RETAINAGE: <br />/ <br />a. 0 % of Completed Work $ <br />0.00 <br />State of Georgia County of: Chatham MIl'11ANI, ALLAN SBEPARD <br />(Column D + E on 0703) <br />Subscribed and sworn to be ire me this 3rd of gpril 2017 <br />b. 10 % of Stored Material <br />0.00 <br />Notary Public: ; / �- NOTARY PUBLIC <br />(Ccluma F on 6703) <br />My Commission ovites: EFFINGHAM COUNTY, GA <br />J/� <br />Total Retainage (lines Sa + Sb or <br />t My Comminion R.rnirps March 8, 2020 <br />Total in Column 1 ofG703) <br />$ <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />6. TOTAL EARNED LESS RETAINAGE <br />$ $322,656.00 <br />In accordance with the Contract Documents, based on on-site observations and the data <br />(Lime 4 Less Linc 5 Total) <br />comprising the application, the Architect certifies to the Owner that to the best of the <br />7. LESS PREVIOUS CERTIFICATES POR PAYMENT <br />Architect's knowledge, information and belief the Work has progressed as indicated, <br />(Line 6 from prior CerriHeate) <br />$1 289,423.20 <br />the quality of the Work is in accordance with the Contract Documents, and the Contractor <br />8. CURRENT PAYMENT DUE <br />$ i:, _ ,,...,3i`A .51. <br />is entitled to payment of the AMOUNT CERTIFIED. <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />$ 28,000.00 <br />(Line 3 less Linc 6) <br />AMOUNT CERTIFIED ........... $ <br />CHANGE ORDER SUMMARY <br />ADDITIONS DEDUCTIONS <br />(Attach explanation ifamount cerfffned dtt ftrsfrom the amount applied Initial ail figures on this <br />Total changes approved <br />Application and onthe Continuation Sheet that are changed to conform with the amount cenifred.) <br />in previous months by Owner <br />50.00 <br />ARCHITECT: <br />Total approved this Month <br />$0.00 <br />By. Date: <br />TOTALS <br />$0.00 <br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein Issuance, payment and acceptance of payment are without <br />NET CHANGES by Change Order <br />$0.00 <br />pr4judice to any rights of the Owner or Contractor under 'this Contract <br />AIA DOCUMENT G702 • APPLICATION AND CERTIFICATION FOR PAYMENT .1992 EDITION - AIA® • 01992 <br />THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, OC 200085292 <br />Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Documents Authenticity from the Licensee. <br />w <br />w <br />