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!tAIA Document G702TtA -1992 Application and Certificate for Payment TO OWNER: Indian River County 1801 27th Street Vero Beach FL 32960 FROM CONTRACTOR: Indian River Docks LLC 481 Avocado AV Sebastian FL 32958 PROJECT: Archie Smith Fish House Restor 1740 Indian River Drive VIA ARCHITECT: Atelier 2709 S.MacDill AV Tampa FL 33602 APPLICATION. NO: 001 PERIOD TO: April 30, 2019 CONTRACT FOR: Archie Smith CONTRACT DATE: PROJECT NOS: 2108056 t Distribution to: OWNER 0 ARCHITECT 0 CONTRACTOR 0 FiELD 0 OTHER 0 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment. as Shown below, in connection with the Contract. AIA Document G7OJTM. Continuation Sheet, is attached. 1. ORIGINAL CONTRACT SUM $ 2. NET CHANGE BY CHANGE ORDERS $ 3. CONTRACT SUM TO DATE (Line I ± 1) $ 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) $ 5. RETAINAGE: a. 10 % of Completed Work (C:oltunns 1) + E on G703) $ 186925.00 19178.90 20610190 206103.90 b. % of Stored Material (Column F on G 703) $ Total Retainage (Lines 5a + 5h, or Total in Column / of G703) $ 6. TOTAL EARNED.LESS RETAINAGE 5206103.90 (Line d minus Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 174422.99 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 minus Lire 6) $ 5 31680.91 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ 19178.90 $ Total approved this month $ 0.00 $ . TOTAL $ 19178.90 $ NET CHANGES by Change Order $ 19178.90 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner. and that current payment show erein is now due. CONTR ' .C_0 By: f/ Sta . 1 elci County of: T., d. c,., K t`Vp Subscribed and sworn to before me this day of A -P apYPIM,. Notnry Public: r L 3, (. ' y4' -• `k My commission expires: 1 Date: "/"'/? Y-7/7 7 DP04 M. 8194. Montt GG 190879 - 28,2022 1twee Swi5eMces Dep ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observatiohs and the data comprising this 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 Contract or is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $ 31, a VI 9 D (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet drat are changedtoconform with the amount certified) AReHIFECC PRDT.+7Z- Bv: Date: Srloller This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA Document G702i10 — 1992. Copyright ® 1953, 1963, 1965, 197i, 1978, 1983 and 1992 by The American Institute of Architects. Alt rights reserved, WARNING: This AlA"' Document Is protected by U.S. Copyri ht Law and International Treaties. Unauthorized reproduction or distribution of this AIA'''Document, or any portion of 1t, may result in severe civil and criminal penalties, and will be prosecuted to the maximum e4[5t possible under the law. This document was created on 10104/2018.08:29:27 under the terms of AIA Documents•on-Oemendr. order no. 2010069708 , end is not for resale. This document is licensed by the American Institute of Architects for one-time use only, end may not be reproduced prior to its completion.