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T Q.-RAIA Document G702T" - 1992 Application and Certificate for Payment TO OWNER: PROJECT: INDIAN RIVER COUNTY 182 IRC FIRE STA #4 - PART 2 APPLICATION N0: Distribution to: PERIOD T0: 1840 25TH STREET 1500 9TH STREET SW 09/30/07 OWNER X VERO BEACH, FL 32960 VERO BEACH, FL 32962 CONTRACT FOR: 182 ARCHITECT El CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 06/01 /06 BARTH CONSTRUCTION, INC. EDLUND & DRITENBAS ARCH . P.A. CONTRACTOR ❑ 1717 INDIAN RIVER BLVD., SUITE 202A 65 ROYAL PALM BLVD., S. D PROJECT NOS: FIELD ❑ VERO BEACH, FL 32960 VERO BEACH, FL 32960 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge, information Application is made for payment, as shown below, in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet, AIA Document G703, is attached. 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 1 . ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2, 182,645 .00 that current payment shown herein is now due. 2. Net change by Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -52,548.97 CONTRACT R: 3. CONTRACT SUM TO DATE (Linc 1 ± 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . ... . $ 2 130.096.03 By F f! Date: �O ) 6 4. TOTAL COMPLETED $ STORED TO DATE (Column G on 6703) . . . . . . $ 2. ] 30,096.03 to ` � � 5. RETAINAGE: C my a• % of Completed Work / 37✓ " UcA� (Column D + E on G703) $ me this day of Subscribed and sworn to before s r b. % of Stored Material ` C' l ow Marion H Tupek P my commiaabn DD339676 (Column F on G703) $ Notary Public:��.,�,i aJ . My Commission expires: 7�Zi /� ora. Expires July 21 , 2006 Total Retainage (Lines 5a + 5b or Total in Column I of G703) . . . . . .. $ 0.00 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. 130.096.03 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 Less Line 5 Total) In accordance with the Contract Documents, based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT . . . . . . . . . . . . . . . . . . . . . . $_2 099.907 23 this application, the Architect certifies to the Owner that to the best of the Architect' s knowledge, (Line 6 from prior Certificate) 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 S. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 30 188 .80 AMOUNT CERTIFIED. /y 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED .. . .. . .. . .. .. . .. . .. . .... .. . .... . .. . .... .... . ., . . , ... ... . .. .. . .. $ . ... . ... . ... . .. (Line 3 less Line 6) $ 000 (Attach expla if amoun ertified differs from the amount applied. Initial all figures on this Application ad o th ti ation .Sheet that are changed to conform with the amount certified ) CHANGE ORDER SUMMARY. ADDITIONS DEDUCTIONS ARCHIT Total changes approved in previous months by Owner $ 0.00 $ 0.00 By: Date: Total approved this Month $ $ 52 548 .97 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the on actor TOTALS $ $ 52 548 .97 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 4 7 the Owner or Contractor under this Contract CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G702ra — 1992. Copyright © 1953, 1963, 1965, 1971 , 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING : This AIA"' Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Ale Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal