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<br /> AIA Document G702TM - 1992 � --
<br /> Application and Certificate for Payment
<br /> TO OWNER: PROJECT : APPLICATION N0: I I Distribution to ::
<br /> INDIAN RIVER COUNTY 204 IRCFD # 12 - PART 2 PERIOD T0 : 11 /25/09 OWNER �"
<br /> 4225 43RD AVENUE 3620 49TH STREET 111
<br /> VERO BEACH, FL 32960 VERO BEACH, FL 32960 CONTRACT FOR: 204 ARCHITECT ❑
<br /> FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE : 09/ 16/08 CONTRACTOR ❑
<br /> BARTH CONSTRUCTION, INC . EDLUND & DRITENBAS ARCH. P.A .
<br /> 1717 INDIAN RIVER BLVD. , SUITE 202A 65 ROYAL PALM BLVD. , S . D PROJECT NOS : / / FIELD ❑
<br /> VERO BEACH, FL 32960 VERO BEACH, FL 32960 OTHER ❑
<br /> CONTRACTOR' S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor' s knowledge,
<br /> information
<br /> Application is made for payment, as shown below, in connection with the Contract. and belief the Work covered by this Application for
<br /> Payment has been completed in accordance
<br /> Continuation Sheet, AIA Document G703 , is attached. with the Contract Documents, that all amounts have been paid
<br /> by the Contractor for Work for
<br /> which previous Certificates for Payment were issued and payments received from the Owner, and
<br /> 1 , ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
<br /> $ 211579964 ,00 that current payment shown herein is now due.
<br /> 2 . Net change by Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
<br /> - 142,838 .77 CONTRA C OR:
<br /> 3. CONTRACT SUM TO DATE (Line 1 ± 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,0159125 .23 By:
<br /> N Date :
<br /> 4, TOTAL COMPLETED & STORED TO DATE (Column G on G703 ) . . . . . . $ 2,0151125 .23 State Lv
<br /> S. RETAINAGE : Con of: IAID,IHV 4Cl VC)CL
<br /> a, % of Completed Work Subscribed and sworn to before
<br /> , ,,, , MMM
<br /> (Column D + E on G703 ) $ me this Z� K day of AfbV �f� � � � � 0 j W AIMIMION # DD 790038
<br /> b. % of Stored Material
<br /> 5kwry
<br /> .
<br /> � IXPIRES: July 21 , 2012
<br /> (Column F on G703) $ Notary Public : BontlWThruWtoryPublic lJndennttors
<br /> My Commission expires :
<br /> Total Retainage (Lines 5a + 5b or Total in Column I of G703) . . . . . . . $ 0 ,00
<br /> 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,0151125 .23
<br /> ARCHITECT' S CERTIFICATE FOR PAYMENT
<br /> (Line 4 Less Line 5 Total) In accordance with the Contract Documents, based on on- site observations and the data
<br /> comprising
<br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT . . . . . . . . . . . . . . . . . . . . . . $ 19961 ,686 .44 this application, the
<br />Architect certifies to the Owner that to the best of the Architect' s knowledge,
<br /> information and belief the Work has progressed as indicated, the quality of the
<br /> Work is in
<br /> (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is
<br /> entitled to payment of the
<br /> 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
<br /> 535438 . 79 AMOUNT CERTIFIED. Q �J
<br /> 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
<br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ C�
<br /> (Line 3 less Line 6) $ 0 ,00 (Attach expla on if amount certifie iffers from the amount applied. Initial
<br />all figures on this
<br /> Applicatio and n the Continu t ' eet that are changed to conform with the amount certified.
<br />)
<br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHIT T:
<br /> Total changes approved in previous months by Owner $ 0 .00 $ 0 . 00 By : Date : ZAC
<br /> Total approved this Month $ 0 .00 $ 142, 838 . 77 This Certificate is not negotiable . The AMOUNT CERTIFIED is payable
<br /> only to the Cont or
<br /> TOTALS $ 0 ,00 $ 142 , 838 . 77 named herein . Issuance, payment and acceptance of payment are without prejudice
<br /> to any rights of
<br /> NET CHANGES by Change Order $ - 142 , 838 . 77 the Owner or Contractor under this Contract.
<br /> CAUTION : You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not
<br /> be obscured.
<br /> AIA Document G702TM — 1992. Copyright @ 1953 , 1963 , 1965, 1971 , 1978, 1983 and 1992 by The American Institute of Architects. All rights
<br /> reserved. WARNING : This AIA® Document is protected by U .S. Copyright Law
<br /> and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal
<br /> penalties, and will be prosecuted to the maximum extent
<br /> possible under the law. Purchasers are permitted to reproduce ten ( 10) copies of this document when completed . To report copyright violations of
<br />AIA Contract Documents, e-mail The American Institute of Architects' legal
<br /> counsel , copyright@aia. org.
<br />
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