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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: Iridian River County PROJECT: Nggth Coiint-vk APPLICATION NO.: 12 Distribution to: 1840 25th Street Indian Rive,County ,approved Date Vero )each, FL 32960-3365 PERIOD TO: Final El OWNER Administration graea PROJECT NOS.: El ARCHITECT Budget El CONTRACTOR FROM CONTRACTOR: Weller Pool Constructors VIA ARCHI CONTRACT DATE: ❑ 1821 S. Orange Blossom Trail o.Attorney C ❑ Apopka, FL 32703 Risk Management CONTRACT FOR: Department Division The un e C ifies that to the best of the Contractor's knowledge,infor- CONTRACTOR S APPLICATION FOR PAYMEN mation an elief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accord nce with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- 1. ORIGINAL CONTRACT SUM. . . . . . . . . . . . . . . . . .$ 2,061,967.00 ments received from the Owner, and that current payment shown herein is now due. > . Net change by Change Orders . . . . . . . . . . . . . . . � 290,124.21) CONTRACTO Weller Pool Constructors, Inc. $ 3. CONTRACT SUM TO DATE (Line I ± 2). . . . . . . .$ 1,771,842.79 By: Date: 12/30/02 4. TOTAL COMPLETED & STORED TO DATE . . . . . .$ 1,771,842.79 State (W Florida (Column G on G703) County of: Orange 5. RETAINAGE: Subscribed and sworn to before HEATHER ATALSKI a. %, of Completed Work $ me this 30th day of December 2002 Notary Public, Slate of Florida (Columns D + E on G703) My Comm. exp. Apr. 15, 2003 b. % of Stored Material $ COMM No. CC827078 (Column F on G703) Notary Public: �4_,t/ Total Retainage (Line 5a + 5b or My Commission expires: Total in Column I of G703) . . . . . . . . . . . . . . . . .$ —0- 6. TOTAL EARNED LESS RETAINAGE. . . . . . . . . . . .$ 1,771,842.79 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In accordance with the Contract Documents,based on on-site observations and the data (Line 6 from prior Certificate) . . . . . . . . . . . . . . . . .$ 1,730,651.92 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 8. CURRENT PAYMENT DUE $ 41,190.87 b quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE O a (Line 3 less Line 6) $ —0— AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 11 b (Attac tion if amount certified differs from the amount applied,for. Initial CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS all fi re n t is �Ipplication and on the Continuation Sheet that are changed to Total changes approved in confp he sn unt certified.) previous months by Owner ARCH ' T. � Total approved this Month By: , Date: �r TOTALS This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- NET CHANGES by Change Order tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA° • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK � - AVENUE, N.W., WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 6702-1992 CAUTION:You should use an original AIA document which has this caution printed in red.An original assures that changes will not be obscured as may occur when documents are reproduced.