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ss AIA Document G703TM - 1992 Continuation Sheet AIA Document G702Tm. Application and Certification for Payment, APPLICATION NO: 11 containing Contractor' s signed certification is attached. APPLICATION DATE: NOV 27,2009 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: 25 ,2009 204 ARCHITECT'S PROJECT N0 : 204 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS BALANCE SCHEDULED FROM PREVIOUSPRESENTLY COMPLETED % ITEM DESCRIPTION OF WORK FINISH RETAINAGE VALUE APPLICATION THIS PERIOD STORED AND STORED (G - C) FSH (If variable rate) NO. TO DATE (D + E) (Not in (D + E + F) (C - G) GENERAL CONDITIONS 25 PROJECT ACCOUNTING 10,320 .00 39291 .69 478 . 80 0.00 39770 .49 36. 5 65549 . 51 0 .00 27 PROJECT ADMIN , 7,740 .00 2, 865 .92 629.44 0.00 3 ,495 . 36 45 .2 41244.64 0.00 28 FIELD SUPERVISION 1299000 .00 1019336.08 119482 .28 0.00 112, 818 . 36 87 . 5 165181 .64 0.00 29 PROJECT MANAGEMENT 865000 .00 37,912 .04 81891 . 10 0.00 469803 . 14 54.4 39, 196. 86 0.00 36 TRAILER RENTAL 2,800.00 1 ,973 .00 0 .00 0 .00 1 ,973 .00 ` 70.5 827 .00 0.00 38 TEMP. WATER 750.00 282 .67 51 .34 0 .00 334 .01 44.5 415 .99 0.00 40 TEMP. POWER 750.00 11323 .96 0.00 0.00 19323 .96 176 .5 573 .96- 0. 00 42 TELEPHONE 19500.00 0.00 0 .00 0.00 0.00 0.0 1 ,500.00 0 .00 44 'TEMPORARY TOILET 11000.00 706. 71 0 .00 0 .00 706. 71 70 .7 293 .29 0.00 50 PROJECT SIGN 500.00 615 .25 0 .00 0 .00 615 .25 123 . 1 115 .25- 0.00 52 TEMPORARY FENCE 21200.00 6,638 .28 0 . 00 0 .00 69638 .28 301 .7 41438 .28- 0 .00 54 FIELD OFFICE SUPPLIES 50.00 0.00 0 . 00 0.00 0 .00 0 .0 50 .00 0 .00 58 TEMP, PROTECTION 19000 .00 686. 74 0 .00 0.00 686 . 74 68 .7 313 .26 0.00 68 FIRST AID 50. 00 0.00 0 .00 0.00 0 .00 0 . 0 50 .00 0.00 70 SAFETY 250.00 0 .00 0. 00 0 .00 0 .00 0. 0 250 .00 0.00 71 PRINTING/POSTAGE 21500 .00 19666. 09 0 . 00 0 .00 1 ,666 .09 66 . 6 833 .91 0 .00 74 PHOTOGRAPHY 50 .00 0.00 0 . 00 0 . 00 0 . 00 0 .0 50 .00 0.00 77 ARCHITECTURAL FEES 499190 . 00 48 , 795 .44 395 .41 0 .00 49, 190 . 85 100 .0 0 . 85 - 0.00 78 ENGINEERING 85500.00 89500 . 00 69650 .00 0 .00 155150 .00 178.2 69650 .00- 0 .00 80 SOIL TESTING 35500 .00 29402 .50 0 .00 0.00 2,402 . 50 68 .6 1 ,097 . 50 0 .00 82 CONCRETE TESTING 19500 . 00 21150.00 0 . 00 0 .00 2, 150.00 143 .3 650 . 00- 0 . 00 88 SM . TOOL/SUPPLIES 3 ,000 .00 19623 . 77 11320 .21 0 .00 2,943 .98 98 . 1 56 . 02 0 . 00 92 HOUSEKEEPING LABOR 31000 .00 39376 . 33 0 .00 0 . 00 31376 . 33 112 . 5 376 . 33 - 0 . 00 GRAND TOTAL 3151150. 00 226, 146 .47 29, 898 . 58 0 .00 2569045 .05 1 1 599104 .95 0 .00 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 G703T - 1992. Copyright © 1963 , 1965 , 1966 , 1967, 1970, 1978t 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 AIA® 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 counsel , copyright@aia .org .