2018-189 - Laserfiche WebLink

Home Browse Search

APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G703 PAGE 1 OF 2 PAGES US 1 Air Release Valve and 24" Forcemain Replacement TO CONTRACTOR: PROJECT: APPLICATION NO: TWO Distribution to: Indian River County -Engineering Division INVOICE NO: 2 _ Owner 1801 27th Street Project # Bid # 2018-047 _ Architect Vero Beach, FL 32960 Attn: Mr. John Boyer, P.E. PERIOD TO: 9/30/2018 _ Contractor Contract date: 5/1/2018 _ FROM (CONTRACTOR): VIA (ENGINEER): Johnson -Davis Inc. Contract: _ 604 Hillbrath Drive Lantana, FL 33462 CONTRACT FOR: US 1 Air Release Valve and 24" Forcemain Replacement CONTRACTOR'S CERTIFICATE FOR PA MENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheets, AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS previous months by Owner 114,658.00 3. CONTRACT SUM TO DATE (Line 1 + 2) TOTAL 0.00 0.00 Approved this Month 0.00 (Column G on G703) Number Date Approved 5. RETAINAGE issued and payments received from the Owner, and that current payment shown Change Order #01 07/31/18 128,658.00 herein is now due. Change Order #02 10/16/18 0.00 (14,000.00) (Line 3 less Line 4) 0.00 CONTRACTOR: Johnson -Davis, Inc. TOTAL 1 128,658.00 14,000.00 Net change by Change Orders 114,658.00 1. ORIGINAL CONTRACT SUM $ 124,000.00 2. Net change by Change Orders $ 114,658.00 3. CONTRACT SUM TO DATE (Line 1 + 2) $ 238,658.00 4. TOTAL COMPLETED & STORED TO DATE $ 238,658.00 (Column G on G703) FOR PAYMENT (Line 6 from prior Certificate) 5. RETAINAGE issued and payments received from the Owner, and that current payment shown 8. CURRENT PAYMENT DUE a. 0% Retainage $ $ 134,802.68 herein is now due. (Column D + E on G703) $ - b. % of Stored Material $ (Line 3 less Line 4) (Column F on G703) CONTRACTOR: Johnson -Davis, Inc. State of: FLORIDA County of: Total Retainage (Line 5a + 5b or Total in Column I of G703) $ LAfiISADITU PELKEY The undersigned Contractor certifies that to the best of the Contractor's Knowledge, 6. TOTAL EARNED LESS RETAINAGE $ 238,658.00 information and belief the Work covered by this Application for Payment has been (Line 4 less Line 5 Total) completed in accordance with the Contract Documents, that all amounts have been 7. LESS PREVIOUS CERTIFICATE paid by the Contractor for Work for which previous Certificates for Payment were FOR PAYMENT (Line 6 from prior Certificate) $ 103,855.32 issued and payments received from the Owner, and that current payment shown 8. CURRENT PAYMENT DUE $ 134,802.68 herein is now due. 9. BALANCE TO FINISH $ - (Line 3 less Line 4) CONTRACTOR: Johnson -Davis, Inc. State of: FLORIDA County of: Palm Beach Subscribed and sworn to before me this 02nd day of October 2018 f PUB,4 LAfiISADITU PELKEY Notary Public: --�_ OO r N� Commission X GG 157707 Expires January 22, 2022 By: Date: 10/2/2018 My Commission expires: 01-22-2022 ''FOF' aettdedTINU& 0Notarysernce: RobertA. Hiv r, V.P. n./ n - n G CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ................................... . (Attach explanation if amount certified differs from the amount applied for.) ARCHIT T' By: Date: G` 4 �h%rrtificate is not negotiable. a AMOUNT CERTIFIED is payable onl to the tra, named herein. Issuance, payment and acceptance of payment are without judice to any rights of the Owner or Contractor under this Contract.