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t =AIA Document G702. 1992 Applicatildw' ndYCertifieate for Payment t TO OWNER µ_ . PROJECT APPLICATION N0: INDIAN RIVER COUNTY - - ' ' S Distribl7tlon;to: 1840 25TH STREET: „ 173 , IRC FIRE STATION#8 _ PER .11� -. 1 I15 BARBER STREET OD TO 04/25/06OWNER ;� UERO:BEACH; FL 32960 . SEBASTIAN FL x32958 CONTRACT FOR. p 173- ARCHITECT O FROM CONTRACTOR: VIA ARCHITECT >' BpRTH CONSTRUCTION`INC EDLUND k DRITENBAS ARCH P p, CONTRACT DATE: I 1/Ol /O5 CONTRACTOR ❑ 1717 INDIAN=RIVER BLVD., SUITE 202A PROJECT Nft 65 ROYAL PALM BLVD:, VER6BEACH, FL 32960 - VERO BEACH FL 32960 FIELD d7 as x * s 4 ' OTHER CONTRACTOR' S APPLICATION`FOR PAYMENT The Ender5sgned contractor ee tfies that to hebest of he Contractor's knowledge, u forma on 7. Apphcanonis made for payment, as shown below, m connection with the Contract �' and belief the Work covered by this Apphcatton for Payment las_been completed m accordance' t„ with the Contract Documents, that all mount' been iii& the Contractor for'Work for; Con or Sheet 'AIA Document,G703- is attached t 1 ORIGIN -1 CONTRACT SUM - - - ? which .previous:Certificates for Payment were issued and payments received from the owner, and: $ 129523 -00 that curre It p eat shown herein is now due: _ 2 Net change by Change Orders $ 15 365 79 CONTRA R: Fx _ 3 CONTRACT SUM-TO DATE (Erne 1 * 2) $ Q �Q By n 4 TOTAL COMPLETED & STORED TO DATE (Column•G on 0703) $ 7,7g S e - Date: 5 RETAINAGE: Co ty of: 9 _y,% of Completed Work (Column D + E on G703) - S scribe and sworn to be p e this da b• of Stored Material - - �- Y of /u r zl p"-a' Marion H Tupek (Column F on G703) - $ - �� /�'�, � ; d Com`masion DD339876 - - - - - . Notary, Public: v � ,L _ "vy"t " . Exprea July r` Z+: zoos Total Retainage (Lines 5a + 5b.or Total in Column I of G703) , . . . . $ ' My Commission expires: o n nn ; R415„Q ARCHITECT' S CERTIFICATE FOR PAYMENT' 6. TOTALine.EARNED LESS RETAINAGE .t $ '- " 1111 - :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 .: . . . . . . . . . . . . . . . . . . . $. - this application, the.Architect certifies to the Owner that to the best of the Architect' s knowledge, '445,351 7C (L,me_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:tfie 8. CURRENT, PAYMENT DUE . . . . . $;� - AMOUNT CERTIFIED. . 9. BALANCE TO FINISH, INCLUDING RETAINAGE _ AMOUNT CERTIFIED . . 3� 3 - .. .. .. .:.. :. . .... .. .. .. (Lme3 less Line 6) - - -.. $ Q Q •,� $ n-nn (AttacOi ex planari a amount cc ed ar, ers from the amount applied. Initial all figures. on this Application an on t e Co tin on Sheet that are changed to egnforui with the amount certified--) CHANGE�ORDER SUMMARY - ADDITIONS v •- DEDUCTIONS ARCHITECT. Total changes approved is previous months by Ou%ner $ _ n `$'• - Total approved this Month _ -00 By' , Date: $ 9. TOTALS' $ $� This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor NET CHANGES b Chan e Order - $ named herein. Issuance, payment and acceptance of payment are without prejudice to any. , of - the Owner or Contractor under this Contract - M. � _ - AIA Document G702nv =:1992. Copyright © 1953, 1963, 1965, 1971 , 1978, 1983 and 1992 by The American Institute of Architects. Allrights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document," or any portion of it, may result in severe civil and criminal penalties, and will u 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, a-mail The American Institute of Architects' legal counsel, copyright@aia:org.