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APPLICATION AND CERTIFICATE FOR PAYMENTAIA DIiiOCUMENT G �02 ( In.slrt,t'linl oil , evc,:,c .sj(It , , ar ; ,, IIN,, Iu: I'O OW NEI( : u�^'r / 4vIII I' NUIIiCI': K S �Q APPLICATION NO . ?&Y�� rihutii .n w: / '0 / L PERIOD 10 ,JL"E"I II ❑ IN III 7yD/�a /��/'mss. � q � SZ? 76 7 PRO, ECI' NOS. : t ❑ AR( :III , Lt :, n / �� ) ��/� ,( ❑ CONII( ACTUIt FROPI CONTRACTOR : �wlt: /P VIA ARCPIITECT✓ //(.E.•/��f rA.T CONTRACT' DATF . ❑ f/q�5S0 �tl-�J2l! 7/ / 9T ❑ CONTRACT "FOR ! ' 2a 911 401 111 The Undersigned Contractor Certifies that H) the best Of the Contractor:s knowledge. infer. CONTRACTOR ' S APPLICATION FOR PAYMENT motion and belief 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 accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet , AIA Document G7U3 . is attached . � Contractor for Work for whine precious Ce rant Lep for Pay shown were issued id and pav. mems received from the Owner, and dot cu creat payment shown herein is now Due. U� I . ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . s `�-,�, 1 Net change by Change Orders . . . . . . . . . . . . . . 3 Z3 ,XJ Q� CONTRACTOR N 3 . CONTRACT SUM TO DATE ( Linc I m 2 ) . . . . . . . f By : Dam : / '02� �0�0 4 . TOTAL COMPLETED & STORED TO DATE . . . . . . 3 /(n�(o (DS. $ State - (Column G on 0703) County of: 5 . RETAINAGE: Subscribed cad sworn to b fore ,'.n CynONe A Huy a- _% of Completed \Vurk x _�• Inc this C;Z--/ da o �u�r IY (Columns O * E on G703 ) S My CorrrgWllin DDICONO b. _% of Stored Material 3 /J wd FxplrM FrOria" 18, 1007 CID (CUIUnIn F on C7U3 ) 0. Notary Public 7bml Retainage (Linc Sa * 5b or My Commission exp es: F TwIal in Column of G703 ) . . . . . . . . . . . . . . . . . i Cl . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . , 3 Z6 ca (p (05- '0 (Line d less Linc 5 Total) ARCHITECT ' S CERTIFICATE FOR PAYMENT (1) 7 . LESS PREVIOUS CERTIFICATES FOR PAYMENT �� In accordance with the Contract Documents, based on on-silt observations and the data C+ E ( Line from prior Certificate) . . . . . . . . . . . . . . . . . 3 0( comprising this application , the Architect certifies to the Owner that to the best of die Architect 's knowledge, information and belief the Work has progressed as indicated, the U 8 . CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . E �S yuaII Uf the Work is in accordance with Lilt Contract Documents, and the Contn,cut 9 . BALANCE TO FINISH , INCLUDING RETAINAGEu �63f8• 30 is entitled to payment of the AMOUNT CERTIFIED. Q ( Linc 3 less Line G) E -_041 AMOUNT CERTIFIED . . . . . . . . . . . . . . . . T 3 (Aimee eApla+aiion if anrou)lt certified differs row the 011101I applied f CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS all r ores rill this f w'. /Mint 1 k Application aid on the Catfnuallon Sheer ibN cape c/rm)ged rn lintel c'ea ngc5 appruvcJ in c'urrfurvn lu !bc raHurrul c'criiJ'ierl.) previous monde by Owner ARCHITECT: Total appiot'ed this Alonth By : Date : TOTALS This Certificate is not negotiable. The AMOUNT CERTIFIED is payable unit, to the Coll- by Chane Order tractor wanted herein . Issuance, payment and accepumce of payment :Ire withoul Prejudice to any rights of (tic Owner or Contractor under this CLllllmet . gIg AIA DOCUMENT G702 • APPLICATION AND CEItTIFTATE FOR PAYMENT • 1992 EDITION • AIA* @1992 • THE AMERICAN 1149111 LITE OF ARCHITECTS. 17,15 NEW PORK 4 M'ENI NAC'., V%h111NGION. D.0 2IeIO(, S292 • WARNING: Unlicensed photocopying violates U.S. '°o rl hi laws and will ..��,. lPY 9 subject the violator to legal prosecution. G702-1892 CAUTION : You should use an original AIA document which has this caution printed In red, An original asoures that changes will not be obscured as may occur When documents are reproduced.