2007-107 - Laserfiche WebLink

Home Browse Search

APPLICATION AND CERTIFICATE FOR PAYMENTAIA DOCUMLNf G702 ( In 1I0CLIOnSOil fevcnt' sit kI I 'At , I; , ink OF �� . / r• � - L1/d' SX//,coWNE /C2V Y , � ' I' I' Llcnl' ' ' N 4 fell lou 10 0❑ stn ,l\ic,nNlnlI!il 'R / PIiOJECI NO'S . . l m I ••••••••��//11 11��1y'� � /q CONT RAC) (-) R FROM CONDI tACTOR : _ yJ %� VIA AIICIIITEC'I AL/ //r ?' , fXA72�s CON "FRAC) DATE : ❑ /��' lUi7 QN�G(' ✓/�7/ /(/� 7FI��/!! J ' �y Li CONTRAC/FFfSR : M 7he undersigned CunlrnctorccOifies dint to the best ofthc Cuntmctur 's knuwlcdgc, inli ,r CONTRACTOR ' S APPLICATION FOR PAYMENT :nation and belief the Work covered by this Application for Payment has been completed rlpplicalion is made for payment , as shown below, In Connection with the Contract , in accordance with the Conlrtet Documents, that all all1UUnts have been paid by the Cuntinu :uiun Sheet , AIA Document G7U3 , is auached . Contractor for Work for which previous Certificates for payment were issued and pay " I . ORIGINAL CONTRACT SUM . . . . . . . . . . . . F / / � CJ'/ latents received front the Owngqer, and ))that current pa)lment shown herein is now one. ' . Net change by Change Orders . . . . / � J CONTRAC'rORJ�A/Le��J 5 . CONTRACT SUM TO DATE ( Line ± ///7- f�X'J�"'� • ( ��_ - L] y ; s _ O., , e . _ _ Z �- •i . TOTAL COMPLETED & STORED TO DATE . . . , . , $ I& C2 66 Stan af: ( Cohunn G on G703J County or RETAINAGE : n , / Subscribed and sworn to b or a . —.".__ 'a, of Co n, plc ted Work x =_ . rX ( L/� . me this � / dad L ( Columns D + Con G7U3 ) 1 AHty b. % of stored Material $ colon Doi 6oi ( CUlun in F on G7U3 ) Notary Public : n ExM ebruli to, 2007 "!oral Retainage ( Line 5a + 5b or Ti-nal in Column I of G703 ) . . . . . . . . . . . . $ _ My Commission expires : (i . TOTAL EARNED Less RETAINAGE ( Line 4 less Line 5 Total ) , . . . . . . . . . . f _ ,. 9g • a � _ ARCHITECT ' S CERTIFICATE FOR PAYMENT 7 . LESS PREVIOUS CERTIFICATES FOR PAYMENTJJ�s In accordance with the Contract Documents, based on on -site observations and the data ( Line (i frnn, prior Certificate) . . . . . . . . . . 3 /L2 . comprising this application , the Architect certifies to the O \eller that to the best OF the rq �� Architect 's knowledge, information and belief the Work has progressed as indicated , the CURRENT PAYMENT DUE . . . . . . . . $ 558 du ;dlty of the AvX/Orli IS in accordance: with the Contract Documents , and the' Contractor 9 . BALANCE TO FIN) SH , INCLUDING RETAINAGE / , a� � AMOUNT CERTIFIED. ( Line 3 less Line 6 � � AMOUNT CERTIFIED of the AMO $— CI Ir\ NEE OItOER SUAI ATARI' (AIIacG espinrrnlZon if an201eW certified differs from Ibe amoristl applied fo) mina / ADDITIONS DEDUCTIONS nil ,figures nil Ibis App( icullon� and On The Cantimialiw, Sheet !brit ore chmiged m final e' hu oyes oppruvcd in e'un(r o m to Ibe nmurrrtl col 11 previous months by Ownr [ _ ARC ) 11 "I ECT: Total 'approv'ed this Month Dale : _ _ TOTALS This Certificate is not negotiable. "I 'lie AMOUNT CERTIFIED is parable onl \' to the Con " NGT (: IiANCE.9 by ChangL Orucr tinc' tnr Manned htneln . Issuance, p:ryn'lem and aeecpntnee of payment :Ire without _ prejudice to any rights of (lie Owner or Contractor under this CunonlCl . AIA DOCUMENT G702 • APPLICA1 ION AND CF. ld IFICnTC FOR PA\' I+IENT 1992 LOTION AIA% © 1992 • THE AMRRICAN INSTITUI"E OF ARCHITECTS, 1715 NEW PORK div A\' ENL' E , N1\". , \e'ASHINCICN. D.C. 2tlnu6.9292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will xihlecl the violator to legal prosecution.\ rr, G702- 1992 CAUTION : You should use an original AIA document which has this caution printed in red . An original assures that changes will not be obscured as may occur when documents are reproduced .