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APPLICATION AND CERTIFICATE FOR PAYMENT
<br />AIA DOCUMENT G702
<br />Application is made for payment, as shown below, in connection with the
<br />OUR INVOICE No. 210572-16Ret
<br />TO OWNER: Indian River County Utilities Dept
<br />PROJECT:
<br />APPLICATION NO.:
<br />16Ret Distribution to:
<br />180127th Street
<br />North County W&S System Ph.2
<br />PERIOD TO:
<br />4/19/2023 C OWNER
<br />Vero Beach, FL 32960
<br />CL PROJECT NO.:
<br />210572 C ARCHITECT
<br />Final Retainage
<br />❑ CONTRACTOR
<br />CONTRACT DATE:
<br />4/20/2021 X ENGINEER
<br />FROM CONTRACTOR: CENTERLINE, INC.
<br />2180 SW Poma Drive
<br />Palen City, FL 34990
<br />(561)689-3917
<br />CONTRACT FOR: Water & Sewer System
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />The undersigned Contractor certifies that to the best of the Contractor's
<br />Application is made for payment, as shown below, in connection with the
<br />knowledge, information and belief the Work covered by this Application for
<br />Contract Continuation Sheet, AIA Document G703, is attached.
<br />Payment has been completed in accordance with the Contract Documents,
<br />$ 63,664.93
<br />that all amounts have been paid by the Contractor for Work for which
<br />1. ORIGINAL CONTRACT SUM ........... _ . ...... ... 3,881,289.00
<br />previous Certificates for Payment were issued and payments received from
<br />the Owner, and that current payment shown herein is now due.
<br />2. Net change by Change Orders ................. ... .... 356,498.78
<br />3. CONTRACT SUM TO DATE (Line 1 + 2) ... ....... $4,237,767.78
<br />4. TOTAL COMPLETED & STORED TO DATE .. .. _ . 4,237,767.78
<br />(Column G on G703)
<br />5. RETAINAGE:
<br />a. 0.0% of Completed Work. 0.00
<br />(Columns D + E on G 703)
<br />b. 0.0% of Stored Material .. 0.00
<br />(Column F on G703)
<br />Total Retainage (Line 5a + 5b or
<br />Total in Column 1 of G703) 0.00
<br />6. TOTAL EARNED LESS RETAINAGE .............. . 4,237,767.78
<br />(Line 4 less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT... ...... 4,025,879.39
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE .... $211,888.39
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6) ..... . ............... 0.00
<br />CHANGE ORDER SUMMARY ADDITIONS
<br />DEDUCTIONS
<br />Total changes approve in previous $ 420,163.71
<br />months by Owner
<br />Total approved this Month
<br />$ 63,664.93
<br />TOTALS $ 420,163.71
<br />$ 63,664.93
<br />NET CHANGES by Chane Order See line 2.
<br />CONTRACTOR:
<br />g CENTERLINE UTILITIES, INC.
<br />tC�G�rtCj 2's
<br />Florida
<br />unty of: Martin
<br />Subscribed and awo to before a�
<br />me this da f
<br />Notary Public:
<br />My Commission expires: 6''" '4 CATHERINE ASH
<br />�7 MYCOMM[SSION#GG325773
<br />�ra,,c/a EXPIRES: May 26, 2023
<br />ARCHITECTS CERTIFICATE FOR PAYMENT
<br />In accordance with the Contract Documents, based on on-site observations and
<br />the data comprising this application, the Architect certifies to the Owner that to the
<br />best of Architect's knowledge, information and belief the Work has progressed
<br />as indicated, the quality of the Work is in accordance with the Contract
<br />Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
<br />AMOUNTCERTIFIED ........ $211,888.39
<br />(attach explanation if amount certified differs from the amount applied for. Initial all
<br />figures on this Application and on the Continuation Sheet that are changed to
<br />conform to the amount certified.)
<br />Engineer MASTELLER S MOILER, INC. - Sean C. Green, PE - Exec. Vice President
<br />gipyptlht�,co�n
<br />IX1. o,R eYV I6,H1 MO,I¢a .,[.
<br />By: .--_. _.....>'�""j-.__.. ,�, .,� Date: 4/28/2023
<br />or Baa+. aeam
<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
<br />without prejudice to any rights of the Owner or Contractor under this Contract.
<br />147
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