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APPLICATION AND CERTIFICATION FOR PAYMENT <br />PROJECT: VAN ANTWERP WELL <br />MITIGATION <br />TO OWNER: <br />INDIAN RIVER COUNTY BOCC <br />1801 27TH ST. <br />VERO BEACH, FL. 32960 <br />FROM CONTRACTOR: <br />All Webb's Enterprises, Inc. <br />309 Commerce Way <br />Jupiter, FL 33458 <br />CONTRACT FOR: VAN ANTWERP WELL <br />ENGINEER: <br />AIA DOCUMENT G702 <br />APPLICATION 4: <br />PERIOD TO: 2/28/2019 <br />PROJECT NOS: <br />CONTRACT DATE: <br />2 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Application is made for payment. as shown below, in connection with the Contract. <br />Continuation Sheet. AIA Document 0703, is attached. <br />I. ORIGINAL CONTRACT SUM <br />2. Net change by Change Orders <br />3. CON'T'RACT SUM TO DATE (Linc 1 t 2) <br />4. TOTAL cOMPLI FED & STORED TO <br />DA'Z'E (Column G on 0703) <br />5. RETAINAGE: <br />a. 10 %ofConlpleted Work $ 50.00 <br />(Column D + E on G703) <br />b. %of Stored Material $ Included in above <br />(Column F on G703) <br />Total Retainage (Lincs 5a + 5b or <br />Total in Column I of G703) <br />6. TOTAL EARNED LESS RETAINAGE <br />(Linc 4 Less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate) <br />8. CURRENT PAYMENT DUE <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) <br />S 107.140.00 <br />S (9,740.00) <br />S 97,400.00 <br />S 97,400.00 <br />s <br />The undersigned Contractor certifies that to thc best of the Contractor's knowledge. <br />information and belief the Work covered by this Application for Payment has been <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 />CONI: <br />ACTOR: atg MOW it22p0'4t%,/ ILC, - <br />Date:l_/gr/fl <br />State of: Florida <br />Subscribed and swontto bcfore_me t <br />Notary Public: <br />My omnissiio expires: <br />1- l cf 2.oto <br />ecqmpnif <br />VL4Z36 3j k uotsslwwop <br />331 SV1OHDIN <br />0.00 ENGINEER'S RECOMMEDATION FOR PAYMENT <br />S 97.400.00 <br />s <br />$ <br />80,280 <br />17,12U.UU <br />0.00 <br />CHANGE ORDER SUMMARY <br />AUDITIONS <br />DLUUCI IONS <br />Total changes approved <br />in previous months by Owner <br />Total approved this Month <br />(59.740.00) <br />TOTALS <br />$0.00 <br />NET CHANGES by Change Order <br />(59,740.00) <br />In accordance with the Contract Documents, based on on-sitc observations and the data <br />comprising thc application, the Architect certifies to thc Owner that to the best of the <br />Architect's knowledge, information and belief the, Work has progressed as indicated, <br />the quality of the Work is in accordance with the Contract Documents, and the Contractor <br />is entitled to payment of the AMOUNT RECOMMENDED. <br />s i7, I7- . `7Q <br />AMOUNT RECOMMENDED <br />(.ltlach explanation if amount certified dif%rs from /he amount applied. Initial all figures on this <br />Application and onthe Continuation Sheet that arc changed to con jarmn with the amount certified) <br />ARC-HWE€T:E�rNcc1 NSE <br />By: �C'^e 7f[ Date: / 3 / 1 <br />This Certificate is not negotiable. 'The AMOUNT RECOMMENDED is payable only to the <br />Contractor named herein. issuance. payment and acceptance of payment arc without <br />prejudice to any rights of the Owner or Contractor under this Contract. <br />MA DOCUMENT 0%62 • APPLICATION MU Chit I IHCAtION FON PAYMr:NY • 199/70150N • AIA • 671992 <br />THE AMERICAN INSTrTUTE OF ARCHITECTS. 1735 NEW YORK AVE.. N.W. WASHINGTON. DC 20008.5292 <br />91 <br />