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HomeMy WebLinkAbout2007-387 7 — LL1%j � APPROVED BY MAR Document G704TM — 2000 NOV o 6 2007 BOARD OF OOMMISSOIONTY Certificate of Substantial Completion PROJECT: PROJECT NUMBER: 070205VB/ OWNER: (Name and address]: CONTRACT FOR: General Construction ARCHITECT. ❑ IRCFD Station #5 CONTRACT DATE: 06/01/06 1500 Vh Street SW CONTRACTOR: Vero Beach, FL 32962 FIELD: ❑ TO OWNER: TO CONTRACTOR: (Name and address): (Name and address): OTHER. ❑ Indian River County Barth Construction 1840 251s Street 1717 Indian River Blvd., Ste 202-A Vero Beach, FL 32960 Vero Beach, FL 32960 PROJECT OR PORTION OF THE PROJECT DESIGNATED FOR PARTIAL OCCUPANCY OR USE SHALL INCLUDE: The Work performed under this Contract has been reviewed and found, to the Architect' s best knowledge, information and belief, to be substantially complete. Substantial Completion is the stage in the progress of the Work when the Work or designated portion is sufficiently complete in accordance with the Contract Documents so that the Owner can occupy or utilize the Work for its intended use. The date of Substantial Completion of the Project or portion designated above is the date of issuance established by this Certificate, which is also the date of commencement of applicable warranties required by the Contract Documents, except as stated below: Warranty Date of Commencement Refund, Dritenbas, Binkley Architects & Assoc., P.A. lhMarch 1, 2007 ARCHITECT BY DATE OF ISSUANCE A list of items to be completed or corrected is at ched eretn. Theat to include any items on such list does not alter the _ responsibility of the Contractor ro complete all k i aecordanehe Contract Documents. Unless otherwise agreed m in writing, the date of commencement of warranties for ems on the attached list will be the date of issuance of the final Certificate of Payment or the date of final payment. Cost estimate of Work that is incomplete or defective: $ 0.00 The Contractor will complete or correct the Work on the list of items attached hereto within Zero ( 0 ) days from the above date of Substantial Completion. L-- B12'CEi (4n► S�R oca .orl 3I Z d —( ONTRAC OR BY 11 1 DATE The Owner accepts the Work or designated portion as substantially co lete and will assume full possession at (time) on (date). 1 Indian River County 11 / 06 / 07 OWNER BY DATE The responsibilities of the Owner and Contractor for security rfWptenance, heat,utilities, damage to the Work and insurance shall be as follows: (Note: Owner 's and Contractor's legal and insurance counsel should dererntme and review insurance requirements and coverage.) AIA Document G704*° - 2000. Copyright C 1963, 1978, 1992 and 2000 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. This document was produced by All software at 13:38:37 on 06/28/2007 under Order No.1000299470_1 which expires on 4/29/2008, and is not for resale. User Notes: (1351341379) 7 — LL1%j � APPROVED BY MAR Document G704TM — 2000 NOV o 6 2007 BOARD OF OOMMISSOIONTY Certificate of Substantial Completion PROJECT: PROJECT NUMBER: 070205VB/ OWNER: (Name and address]: CONTRACT FOR: General Construction ARCHITECT. ❑ IRCFD Station #5 CONTRACT DATE: 06/01/06 1500 Vh Street SW CONTRACTOR: Vero Beach, FL 32962 FIELD: ❑ TO OWNER: TO CONTRACTOR: (Name and address): (Name and address): OTHER. ❑ Indian River County Barth Construction 1840 251s Street 1717 Indian River Blvd., Ste 202-A Vero Beach, FL 32960 Vero Beach, FL 32960 PROJECT OR PORTION OF THE PROJECT DESIGNATED FOR PARTIAL OCCUPANCY OR USE SHALL INCLUDE: The Work performed under this Contract has been reviewed and found, to the Architect' s best knowledge, information and belief, to be substantially complete. Substantial Completion is the stage in the progress of the Work when the Work or designated portion is sufficiently complete in accordance with the Contract Documents so that the Owner can occupy or utilize the Work for its intended use. The date of Substantial Completion of the Project or portion designated above is the date of issuance established by this Certificate, which is also the date of commencement of applicable warranties required by the Contract Documents, except as stated below: Warranty Date of Commencement Refund, Dritenbas, Binkley Architects & Assoc., P.A. lhMarch 1, 2007 ARCHITECT BY DATE OF ISSUANCE A list of items to be completed or corrected is at ched eretn. Theat to include any items on such list does not alter the _ responsibility of the Contractor ro complete all k i aecordanehe Contract Documents. Unless otherwise agreed m in writing, the date of commencement of warranties for ems on the attached list will be the date of issuance of the final Certificate of Payment or the date of final payment. Cost estimate of Work that is incomplete or defective: $ 0.00 The Contractor will complete or correct the Work on the list of items attached hereto within Zero ( 0 ) days from the above date of Substantial Completion. L-- B12'CEi (4n► S�R oca .orl 3I Z d —( ONTRAC OR BY 11 1 DATE The Owner accepts the Work or designated portion as substantially co lete and will assume full possession at (time) on (date). 1 Indian River County 11 / 06 / 07 OWNER BY DATE The responsibilities of the Owner and Contractor for security rfWptenance, heat,utilities, damage to the Work and insurance shall be as follows: (Note: Owner 's and Contractor's legal and insurance counsel should dererntme and review insurance requirements and coverage.) AIA Document G704*° - 2000. Copyright C 1963, 1978, 1992 and 2000 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. This document was produced by All software at 13:38:37 on 06/28/2007 under Order No.1000299470_1 which expires on 4/29/2008, and is not for resale. User Notes: (1351341379) T I Document G706TM - 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: ❑ IRC Fire Station #5 ARCHITECT: ❑ 6585 U.S. Highway I CONTRACT FOR: General Construction CONTRACTOR: ❑ Vero Beach, FL 32967 SURETY: ❑ TO OWNER: (Name and address) CONTRACT DATED: 5/24/06 OTHER: ❑ Indian River County 1840 25th Street Vero Beach, FL 32960 STATE OF: Florida COUNTY OF: Indian River The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or Owner' s property might in any way be held responsible or encumbered. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1 . Consent of Surety to Final Payment. Whenever Barth Construction, Inc. Surety is involved, Consent of Surety is 1717 Indian River Blvd.. Suite 202A required. AIA Document 6707, Consent of Vero Beach, FL 32960 Surety, may be used for this purpose Indicate Attachment ® Yes ❑ No , BY: An The following supporting documents should be attachedignature of authorized representative) hereto if required by the Owner: 1 . Contractor' s Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. Notary Public: 3. Contractor' s Affidavit of Release of Liens My Commission Expires: (AIA Document G706A). AIA Document G706re - 1994. Copyright m 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING : This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, 1 may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 08:54:20 on 10/17/2007 under Order No. 1000304448_1 which expires on 5/29/2008, and is not for resale. User Notes: (3821035828) T I Document G706TM - 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: ❑ IRC Fire Station #5 ARCHITECT: ❑ 6585 U.S. Highway I CONTRACT FOR: General Construction CONTRACTOR: ❑ Vero Beach, FL 32967 SURETY: ❑ TO OWNER: (Name and address) CONTRACT DATED: 5/24/06 OTHER: ❑ Indian River County 1840 25th Street Vero Beach, FL 32960 STATE OF: Florida COUNTY OF: Indian River The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or Owner' s property might in any way be held responsible or encumbered. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1 . Consent of Surety to Final Payment. Whenever Barth Construction, Inc. Surety is involved, Consent of Surety is 1717 Indian River Blvd.. Suite 202A required. AIA Document 6707, Consent of Vero Beach, FL 32960 Surety, may be used for this purpose Indicate Attachment ® Yes ❑ No , BY: An The following supporting documents should be attachedignature of authorized representative) hereto if required by the Owner: 1 . Contractor' s Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. Notary Public: 3. Contractor' s Affidavit of Release of Liens My Commission Expires: (AIA Document G706A). AIA Document G706re - 1994. Copyright m 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING : This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, 1 may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 08:54:20 on 10/17/2007 under Order No. 1000304448_1 which expires on 5/29/2008, and is not for resale. User Notes: (3821035828) :==AI Document G706X — 1994 Contractor's Affidavit of Release of Liens PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: ❑ IRC Fire Station #5 6585 U .S. Highway 1 CONTRACT FOR: General ARCHITECT: E] Vero Beach, FL 32967 Construction CONTRACTOR: ❑ TO OWNER: (Name and address) CONTRACT DATED: 5/24/06 SURETY: ❑ Indian River County 1840 25th Street OTHER: ❑ Vero Beach, FL 32960 STATE OF: Florida COUNTY OF: Indian River The undersigned hereby certifies that to the best of the undersigned' s knowledge, information and belief, except as listed below, the Releases or Waivers of Lien attached hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work, labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner arising in any manner out of the performance of the Contract referenced above. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1 . Contractor' s Release or Waiver of Liens, Barth Construction, Inc. conditional upon receipt of final payment. 1717 Indian River Blvd . , Suite 202A Vero Beach, FL 32960 2. Separate Releases or Waivers of Liens from BY: - " h1/ Subcontractors and material and equipment Signature of authorized suppliers, to the extent required by the Owner, 'entative) accompanied by a list thereof. t/f/S +/� (Printed name and title) Subscribed and swom to before me on this date: Notary Public : My Commission Expires: AIA Document G706Aw — 1994. Copyright C 1982 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This Al e Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, of any 1 portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 08:56:16 on 10/17/2007 under Order No. 1000304448_1 which expires on 5129/2008, and is not tot resale, User Notes: (2167666425) CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER ❑ PROJECT: Design Build Expansion and Renovation to the Indian River County Dept. of (name, address) Emergency Services Fire Station #5, 6586 US Highway 1 , Vero Beach , FL 32976 TO (Owner) : Indian River County, Florida ARCHITECT'S PROJECT NO : CONTRACT FOR: Construction BOND NO : 54-161409 CONTRACT DATE: 05/03/2006 CONTRACTOR: Barth Construction , Inc . In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) United Fire & Casualty Company 118 Second Avenue SE , Cedar Rapids , IA 52401 (319) 399-5700 SURETY COMPANY, on bond of (here insert time and address of Contractor) Barth Construction , Inc. 1717 Indian River Blvd, Suite #202A, Vero Beach , FL 32960 (772) 778 -3072 CONTRACTOR, hereby approves of the final payment to the Contractors, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Oumer) Indian River County, Florida 1840 25th St. ( BOCC address) , Vero Beach , FL 32960 (772) 567-8000 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 18th day of October, 2007 . United Fire & Casualty Company Surety Company f vim" 4 a n ' � p Signature of Authorized Representative Attest: f l ,(Mp (Seal): Leslie M . Donahue , Attorney-In -Fact & Florida Title Licensed Resident Agent Inquiries. (407) 786- 7770 NOTE: This form is to be used as a companion document to ALA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIAO ONE PAGE © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave., NW, WASHINGTON , DL_ 20006 :==AI Document G706X — 1994 Contractor's Affidavit of Release of Liens PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: ❑ IRC Fire Station #5 6585 U .S. Highway 1 CONTRACT FOR: General ARCHITECT: E] Vero Beach, FL 32967 Construction CONTRACTOR: ❑ TO OWNER: (Name and address) CONTRACT DATED: 5/24/06 SURETY: ❑ Indian River County 1840 25th Street OTHER: ❑ Vero Beach, FL 32960 STATE OF: Florida COUNTY OF: Indian River The undersigned hereby certifies that to the best of the undersigned' s knowledge, information and belief, except as listed below, the Releases or Waivers of Lien attached hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work, labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner arising in any manner out of the performance of the Contract referenced above. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1 . Contractor' s Release or Waiver of Liens, Barth Construction, Inc. conditional upon receipt of final payment. 1717 Indian River Blvd . , Suite 202A Vero Beach, FL 32960 2. Separate Releases or Waivers of Liens from BY: - " h1/ Subcontractors and material and equipment Signature of authorized suppliers, to the extent required by the Owner, 'entative) accompanied by a list thereof. t/f/S +/� (Printed name and title) Subscribed and swom to before me on this date: Notary Public : My Commission Expires: AIA Document G706Aw — 1994. Copyright C 1982 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This Al e Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, of any 1 portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 08:56:16 on 10/17/2007 under Order No. 1000304448_1 which expires on 5129/2008, and is not tot resale, User Notes: (2167666425) UNITED FIRE & CASUALTY COMPANY HOME OFFICE - CEDAR RAPIDS, IOWA CERTIFIED COPY OF POWER OF ATTORNEY r(Original on file at Home Office of.Company - See Certification) . KNOW ALL MEN BY THESE PRESENTS That the UNITED FIRE`& CASUALTY COMPANY, a corporationduly organized and existing under the laws of the:State of towa , and having its principal office in Cedar Rapids, State of Iowa, does make, constitute and ' : appoint: LESLIE M DONAHUE , OR. KIM E . NIV , OR JEFFREY W REICH , OR. SUSAN L. REICH , . OR TERESA. L DURHAM , OR PATRIICIA L SLAUGHTER , OR J ': GREGORY MACKENZIE , . OR WALTER N MYERS , OR GLORIA A RICHARDS , OR DON BRAMLAGE OF DAYTONA BEACH FL , ALL INDIVIDUALLY of MAITLAND FL its true and lawful Attorneyjs)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf alllawful bonds undertakings andotherobligatory Instruments of similar nature as follows: Any and Al I Bonds , " and to bind::UNITED FIRE & CASUALTY COMPANY thereby as fully and to the same extent as if such Instruments were signed by the duly authorized officers of UNITED FIRE & CASUALTY COMPANY and all the acts of said Attorney, pursuant to the authority hereby given are hereby ratified and..confirmed . The Authority hereby granted is continuous and shall remain in full force and effect until revoked by UNITED FIRE & CASUALTY COMPANY ` ` >This power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by Board of Directors of the Company on April 18, 1973. "Article V - Surety. Bonds and Undertakings" Section 2 Appointment of Attorney-in-Fact. "The President or any Vice President, or any other officer of the Company may, from time to time, appoint by written certificates attorneys-in-fact to act in behalf of the Company in the execution of policies of insurance, bonds,. .undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal , when so used , being adopted by the Company as the original signature of such :officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. Such attomeys-in fact, subject to the limitations set forth . in their respective certificates of authority shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company thereto. The President or any Vice President, the Board of Directors or any other officer of the Company may at any time revoke all power and authority previously given to any. attorney-in-fact vialli,lf IN WITNESS WHEREOF, the UNITED FIRE & CASUALTY COMPANY has caused these presents to be signed by - 3 rc ;,°v Its vice president and its corporate seal to be hereto affixed this 15th day of May , 2007 :+ enRroRATF f ' x§ UNITED FIRE & CASUALTY COMPANY By State of Iowa , County of Linn , ss On. 15th da of May , ;. 2007 , before me Vice President Y personally came Dennis J . Richmann to me known,: who being by me duly sworn , did depose and say, that he resides in Cedar Rapids, State of Iowa; that he is' a Vice President of the UNITED FIRE .&: CASUALTY COMPANY, the corporation described in and which executed the above instrument that he knows the seal of said corporation ; that the seat affixed to the said instrument is such corporate seal ; that it was so affixed pursuant to authority given by the,:Board of. Directors of said corporation and that he signed his name thereto pursuant .. to like. - authority, and acknowledges same to be the act and deed of said corporation MICHELLE' qwRNILOW 704 YC 1 . /�/1 ' COYN188iON NUMBER TM74S ) �( — ' S I MY COMM SSION EXPIRES �`� JJ /// YYY ��` NotaryPublic I , the undersigned officer of the UNITED FIRE & CASUALTY COMPANY, do hereby certify that I . have compared the foregoing copy of the Power: of Attorney and affidavit, and the copy of the Section of the by4aws of said Company as set forth` In. said Power of Attorney, with : the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID COMPANY and that the same arecorrect transcripts thereof, and of the whole of the said originals,: and that the said Power of Attorney has not been revoked and is now in fullforce and - effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Company this 1 811-h _ day of October 20 07 IN z` IQRWRArF AMI MI Secretary BPOA00190706 CHANGE ORDER Distribution to : AIA DOCUMENT G701 OWNER ARCHITECT CONTRACTOR FIELD OTHER PROJECT: CHANGE ORDER NUMBER: 5 I . R.C . Fire Station 95 6585 U . S. Highway I Vero Beach, FL 32967 INITIATION DATE: 10/ 11 /07 TO (Cortractor): r -I ARCHITECT' S PROJECT NO : Barth Construction, Inc . 1717 Indian River Blvd. CONTRACT FOR : Suite 202A L Vero Beach, FL 32960 J CONTRACT DATE: You are directed to make the following changes in this Contract: Owner Direct Purchase From 4/2107- 10/ 1 /07. See Attached. P.O. Balance Tax Total IRC P.O . a 00041273-00 Hughes Plumbing Supply $54.00 $3 .59 $57.59 Total of Change Order $57.59 Not valid until signed bV both the Architect and Owner. Signature oCthe Contractor indicates his agreement herewith, including any adjustment in the Contract Sum or Contract Time The Original ( Contract Sum) (Gaafanteed Maximum Cost) was . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2, 143,518.00 Net change by previously authorized Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -$ 242,995 . 13 The (Contract Sum) (Guaranteed Maximum Ces4) prior to this Change Order was . . . . . . . . . . . . $ 1 ,900,522. 87 The (Contract Sum) (Guaranteed Maximum CosO will be (iasfeasedj (decreased) (Hfl d) bythis Change Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. -$ 57.59 The new (Contract Sum) (G .ar- teed P 4wimm nt Cost` including this Change Order will be $ 1 ,900,465 .28 The Contract Time will be 'inefeased) (decreased) (unchanged) by ( ) Days The Date of Substantial Completion as of the date of this Change Order therefore is ARCHITECT CONTRACTOR OWNER Edlund, Dritenbas, Binkley, Arch . Barth Construction Indian River County Dept. of Emer. 65 Rove ! Palm Blvd., Suite D 1717 Indian River Blvd. 1840 25'' Street Vero Beach, F1 . 32960 Suite 202A Vero Beach, FL 32960 Vero Beach, FL 32960 BY: 0 0 7 DATE : A 6 1t 6 DATE : I Q6 AIA DOCt; MEN T G701 ' HANGSORDER APRII . 1978 EDITION " AIA ` 1978 THE AMERICAN INSTITt,TE OF ARC] IITECTS, 1735 NEW YORK AVE_, N.W., WASHINGTON, D.C. 20006 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER ❑ PROJECT: Design Build Expansion and Renovation to the Indian River County Dept. of (name, address) Emergency Services Fire Station #5, 6586 US Highway 1 , Vero Beach , FL 32976 TO (Owner) : Indian River County, Florida ARCHITECT'S PROJECT NO : CONTRACT FOR: Construction BOND NO : 54-161409 CONTRACT DATE: 05/03/2006 CONTRACTOR: Barth Construction , Inc . In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) United Fire & Casualty Company 118 Second Avenue SE , Cedar Rapids , IA 52401 (319) 399-5700 SURETY COMPANY, on bond of (here insert time and address of Contractor) Barth Construction , Inc. 1717 Indian River Blvd, Suite #202A, Vero Beach , FL 32960 (772) 778 -3072 CONTRACTOR, hereby approves of the final payment to the Contractors, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Oumer) Indian River County, Florida 1840 25th St. ( BOCC address) , Vero Beach , FL 32960 (772) 567-8000 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 18th day of October, 2007 . United Fire & Casualty Company Surety Company f vim" 4 a n ' � p Signature of Authorized Representative Attest: f l ,(Mp (Seal): Leslie M . Donahue , Attorney-In -Fact & Florida Title Licensed Resident Agent Inquiries. (407) 786- 7770 NOTE: This form is to be used as a companion document to ALA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIAO ONE PAGE © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave., NW, WASHINGTON , DL_ 20006 1011012007 Indian River County , Fire Station #5 - Direct Purchase Log Bealnudinit Balance Current Previous Owner CO Cost Sub. Add. Date Vendor P.O. Amt Tax P.O. + Tax Current Sales Current Prev Sales Total Remain P.O, Issued Code Issued P.O. # Issued Real. # Material Supplier) Subcontractor (Net $) . Savings $ Amount Inv Tax Total Inv4d Tax Inv Balance E 1 11450 Atld. 1 00041145-00 6/1 /06 2624 Statewide LaundryEquip Statewide LaundryEquip 5,120.00 358.40 5,478.40 $0.00 $000 5,12000 $358.40 $5,478.40 $0.00 _ 1 _ 6050 Add. 1 00041139-00 6/1 /06 2621 Stock Components Stock Components 22,100.00 1 ,376.00 23,476.00 $0.00 $0.00 22,10000 $1 ,378.00 $23,476.00 $0.00 _1 11600 Add. 1 00041141 -00 6/1 /06 2622 Mid-Minnesota Wire Mid-Minnesota Wire 8,498.00 559.88 9,057.88 $0.00 $000 8,49800 $559.88 $9,05788 $0.00 _ 1 8103 Add. 1 00041143-00 611 /06 2623 Doarwa Corporation Doorwa Corsoration 39,40000 2,414.00 41 ,814.00 $0.00 $0.00 39,40000 $2,414.00 $41 ,814.00 $0.00 _1 11450 Add. 1 00041255-00 6/20/06 2775 Designs, Furn & E ui Designs, Furn & Equip 7,660.00 50900 8,169.00 $0.00 $0 00 7,660.00 $50900 $8,16900 $0.00 _�_... 1 15801 Atld. 1 00041254-00 _6/20/06 2774 Designs, Furn 8 Equip Designs Furn 8 Equip 12,120.00 777.20 12,897.20 $0.00 $0.00 12,120.00 $777.20 $$2,897.20 $0.00 1 15400 Atld. 1 00041273-00 6122106 2790 Hughes Plumbing Supply, Ltd. Southern Plumbing 7,221 .38 478.99 7,700.37 0.00 $0.00 $0.00 2,027.70 $134.50 $2162.20 5193.68 4 _15400 Add. 2 00041273.00 7/25107 Reverse Balance on PO Southern Plumbing -5,247.68 -348.08 -5,595.76 -$5,247.68 5 Correct Balance reversed 54.00 3.59 57.59 $54.00 1 _ 16003 Add. 1 00041272.00 6122/06 _ 2789 TAW Power Sy stems Complete Electnc 3400000 2.09000 36,09000 $000 $0.00 34,000.00 $2,090.00 $36,090.00 $0.00 1 - 2000 Adtl_1 00041251 -00 6/20/06 _ . 2776 ABS Pumps, Inc_ _ Cathco 17,790.00 1,09240 1888240 $000 $0.00 17,79000 $1 ,09240 $18882.40 $0.00 1 _ 9015 Add -1 00041294-00 8/27/06 _281_7 SeacoastSupply _ _ Florida Preferred Contractors 9,439.25 66075 1010000 $0.00 $0.00 6,791 .65 $47542 $7267.07 $2,647.60 4 9015 Atld. 6 00041294-00 7125107 Reverse Balance an PO Florida Preferred Contractors -2,647.60 -185.33 -2,832.93 -$2.647.60 2 11450 - 00041496-00 8/2106 3082 Designs, Tum & E ui . Desi ng s, Furn & Equip940.00 65.80 1005.80 $0.00 $000 94000 $6580 $1 ,00580 $0.00 _ 2 _ 6000 - 00041679-00 _ 916/063327 Stock Building Supply _ Stock Building Supply 15,538.12 1 ,087.68 16,625.80 $000 $000 15,51487 $1 ,086.05 $16,600.92 $23.25 4 6000 00041679-00 7/25/07 Reverse Balance on PO Stock Building Supply -2335 -1 .63 -24.88 $0.00 $0.00 -$23.25 2 16000 At i 00041725-00 9/13/08 3374 Rexel Southern Complete Electric 32,890.00 2302.30 35192.30 $000 $000 3268376 $2,287.86 $34,97162 $206.24 4 16000 Add, 5 00041725.00 7/25/07 Reverse Balance on PO Complete Electric -206.24 -14.44 -220.68 $0.00 $0.00 -$206.24 3 15600 Ati 00043597-00 10/9/06 771 Trane Company Barker Air Conditioning 13,97100 888.26 14,859.26 Cancelled $0.00 $0.00 0.00 $0.00 $0.00 Cancelled 4 Reverse Balance on PO .13 971 .00 488.26 -14,859.26 3 15800 Add. 2 00043588-00 10/6/06 782 Baker Drstributino Co. Barker Air Conditionina 9,41200 614.72 10,026.72 $0.00 $0.00 9,41200 $614.72 $10,026.72 $0.00 3 15800 Add, 3 00043602-00 1 10/9106 1 769 Tom Bartow Co. Barker Air Conditioning 2,161 .00 151 .27 2,312.27 Cancelled $000 $0.00 0.00J$888.26 $000 Cancelled 4 Reverse Balance on PO -2161 .00 -161 .27 -2 312.27 4 00044442-00 1 /24/07 1658 Statewide LaundryEquip Statewide LaundryEquip 27500 19.25 294.25 $000 $0.00 275.00 $29425 $0.00 4 15600 Add. 6 00044835-00 4/2107 2164 Barker Air Condidionin Barker Air Conditioning13,971 .00 888.26 14,859.26 $0.00 $0.00 13,971 .00 $14,85926 $0.00 $000 $000 $000 $000 Totals To Date 228,303.98 14,74874 243052.72 $0.00 $000 $0.00 $22830399 $ , $243,052.72 $0.00 CHANGE ORDER Distribution to: AIA DOCUMENT G701 OWNER ARCHITECT CONTRACTOR _ FIELD _ OTHER PROJECT: CHANGE ORDER NUMBER: 6 I.R.C . Fire Station 45 6585 U.S . Highway 1 Vero Beach, FL 32967 INITIATION DATE: 10/ 11 /07 TO (Contractor): I— 1 ARCHITECT' S PROJECT NO: Barth Construction, Inc. 1717 Indian River Blvd. CONTRACT FOR: Suite 202A L Vero Beach, FL 32960 J CONTRACT DATE: You are directed to make the following changes in this Contract: Final Cost of Construction (Including Contractor' s Fee) $ 108,702 .90 Less Current Contract Amount <$ 11900,465 .28> Change Order Amount <$91,762.38> Not valid until signed by both the Architect and Owner. Signature of the Contractor indicates his agreement herewith, including any adjustment in the Contract Sum or Contract Time The Original (Contract Sum) (GuaF Meed n,r...,:..,um Cost) was . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . $2, 143,518.00 Net change by previously authorized Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -$ 243,052.72 The (Contract Sum) prior to this Change Order was . . . . . . . . . . . . $ 1 ,900,465 .28 The (Contract Sum) (GaaFmteed " a. � :.. um Cost) will be (iasreased) (decreased) (utiehanged) by this Change Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. -$ 91 ,762.38 The new (Contract Sum) including this Change Order will be $ 1 ,808,702.90 The Contract Time will be (inereased) (decreased) (unchanged) by ( ) Days The Date of Substantial Completion as of the date of this Change Order therefore is ARCHITECT CONTRACTOR OWNER Edlund, Dritenbas, Binkley, Arch. Barth Construction Indian River County Dept. of Emer. 65 Royal Palm Blvd., Suite D 1717 Indian River Blvd. 1840 25" Street 4 • , Vero Beach, FL 32960 Suite 202A Vera Rgacb, FL320,6(!t , AUL U • Visit Vero Beach, FL 32960 DATE: rC Zeo oaf� f�� DATE AIA DOCUMENT G701 * .RANGE ORDER * APRIL 1978 EDITION * AIA * 1978 THE AMERICAN INSTITUTE F ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 UNITED FIRE & CASUALTY COMPANY HOME OFFICE - CEDAR RAPIDS, IOWA CERTIFIED COPY OF POWER OF ATTORNEY r(Original on file at Home Office of.Company - See Certification) . KNOW ALL MEN BY THESE PRESENTS That the UNITED FIRE`& CASUALTY COMPANY, a corporationduly organized and existing under the laws of the:State of towa , and having its principal office in Cedar Rapids, State of Iowa, does make, constitute and ' : appoint: LESLIE M DONAHUE , OR. KIM E . NIV , OR JEFFREY W REICH , OR. SUSAN L. REICH , . OR TERESA. L DURHAM , OR PATRIICIA L SLAUGHTER , OR J ': GREGORY MACKENZIE , . OR WALTER N MYERS , OR GLORIA A RICHARDS , OR DON BRAMLAGE OF DAYTONA BEACH FL , ALL INDIVIDUALLY of MAITLAND FL its true and lawful Attorneyjs)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf alllawful bonds undertakings andotherobligatory Instruments of similar nature as follows: Any and Al I Bonds , " and to bind::UNITED FIRE & CASUALTY COMPANY thereby as fully and to the same extent as if such Instruments were signed by the duly authorized officers of UNITED FIRE & CASUALTY COMPANY and all the acts of said Attorney, pursuant to the authority hereby given are hereby ratified and..confirmed . The Authority hereby granted is continuous and shall remain in full force and effect until revoked by UNITED FIRE & CASUALTY COMPANY ` ` >This power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by Board of Directors of the Company on April 18, 1973. "Article V - Surety. Bonds and Undertakings" Section 2 Appointment of Attorney-in-Fact. "The President or any Vice President, or any other officer of the Company may, from time to time, appoint by written certificates attorneys-in-fact to act in behalf of the Company in the execution of policies of insurance, bonds,. .undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal , when so used , being adopted by the Company as the original signature of such :officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. Such attomeys-in fact, subject to the limitations set forth . in their respective certificates of authority shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company thereto. The President or any Vice President, the Board of Directors or any other officer of the Company may at any time revoke all power and authority previously given to any. attorney-in-fact vialli,lf IN WITNESS WHEREOF, the UNITED FIRE & CASUALTY COMPANY has caused these presents to be signed by - 3 rc ;,°v Its vice president and its corporate seal to be hereto affixed this 15th day of May , 2007 :+ enRroRATF f ' x§ UNITED FIRE & CASUALTY COMPANY By State of Iowa , County of Linn , ss On. 15th da of May , ;. 2007 , before me Vice President Y personally came Dennis J . Richmann to me known,: who being by me duly sworn , did depose and say, that he resides in Cedar Rapids, State of Iowa; that he is' a Vice President of the UNITED FIRE .&: CASUALTY COMPANY, the corporation described in and which executed the above instrument that he knows the seal of said corporation ; that the seat affixed to the said instrument is such corporate seal ; that it was so affixed pursuant to authority given by the,:Board of. Directors of said corporation and that he signed his name thereto pursuant .. to like. - authority, and acknowledges same to be the act and deed of said corporation MICHELLE' qwRNILOW 704 YC 1 . /�/1 ' COYN188iON NUMBER TM74S ) �( — ' S I MY COMM SSION EXPIRES �`� JJ /// YYY ��` NotaryPublic I , the undersigned officer of the UNITED FIRE & CASUALTY COMPANY, do hereby certify that I . have compared the foregoing copy of the Power: of Attorney and affidavit, and the copy of the Section of the by4aws of said Company as set forth` In. said Power of Attorney, with : the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID COMPANY and that the same arecorrect transcripts thereof, and of the whole of the said originals,: and that the said Power of Attorney has not been revoked and is now in fullforce and - effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Company this 1 811-h _ day of October 20 07 IN z` IQRWRArF AMI MI Secretary BPOA00190706 V.:AIA Document G702TM - 1992 Application and Certificate for Payment TO OWNER: PRR JECT: IRC FIRE STA #5 - PART 2 APPLICATION N0: INDIAN RIVER COUNTY l8� Distribution to: 1840 25TH STREET 6586 US 1 PERIOD TO: 09/30/07 OWNER VERO BEACH, FL 32960 WABASSO, FL 32967 184 CONTRACT FOR: ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 06/01 /06 BARTH CONSTRUCTION, INC. EDLUND & DRITENBAS ARCH. P.A . CONTRACTOR ❑ 1717 INDIAN RIVER BLVD., SUITE 202A 65 ROYAL PALM BLVD., S. D PROJECT NOS: ❑ VERO BEACH, FL 32960 VERO BEACH , FL 32960 FIELD OTHER ❑ CONTRACTOR' S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractor' s knowledge, information Application is made for payment, as shown below, in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet, AIA Document G703, is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 2, 143 ,51 00 which previous Certificates for Payment were issued and payments received Irom the Owner, and 1 . ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ $ that current ay own herein is now due. 2. Net change by Change Orders . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . $ '334,8151 CONTRA OR: 3. CONTRACT SUM TO DATE (Line I t 2) . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... . .. $ 1 ,808,702 .90 By: Date: �d it o 4. TOTAL COMPLETED & STORED TO DATE (Column G on 6703) . . . . . . $ 1 ,808,702 .90 St f: ' ���f-� 5. RETAINAGE: my of: � / � a• % of Completed Work (Column D + Eon G703) $ ubscribed and sworn to before methis li day oft)Cj� oqi b• vin of Stored Material //// �e� 'qk Marion H Tupek L - - r+tr Commisabn DD339676 (Column F on G703) $ Notary Public : �— g l / Aptidr Expires July 2i , 2006 Total Retainage (Lincs Sa + 56 or Total in Column T of G703) . . . . . . . $ 0.00 My Commission expires: 9 �Zi /� 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 118083702.90 ARCHITECT' S CERTIFICATE FOR PAYMENT (Linc 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 . . . . . . . . . . . . . . . . . . . . . . $ 15773 ,564.91 this application, the Architect certifies to the Owner that to the best of the Architect' s knowledge, (Line 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 the 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35, 137.99 AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED . . . . . . .. . .. .. .. . .. .. . . ..... . . ... . . .. . ... . . .:. . ... ... ... .. .. . $ 1l�; �� 7 1 . .... . .. . . ... . ... . (Linc 3 less Line 6) $ 0.00 (Attach e,rp[ana' amount red diff"ers fi orrt the amount applied. Initial a12,('tgure.c oil this Appheatioa an on r e anti ua an Shect Khat fire changed to con/orm with the amount certified j CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT• Total changes approved in previous months by Owner $ 0.00 $ 253 ,687.40 12 �T 7,e.'t�� BY: Date: Total approved this Month $ 10,692 .27 $ 91 ,819.97 9 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 10,692 .27 $ 345,507.37 named herein . Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ -334, 815 . 10 the Owner or Contractor under this Contract 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 G7027e — 1992. Copyright © 1953, 1963, 1965, 1971 , 1978, 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 AIAO 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. _AIADocument G702r°" - 1992 Instructions Application and Certificate for Payment GENERAL INFORMATION Purpose and Related Documents AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA . Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement ITULA) . To report copyright violations of AIA Contract Documents , e-mail The American Institute of Architects' legal counsel, copyright@aia.org. COMPLETING THE G702 FORM After the Contractor has completed AIA Document G703 , Continuation Sheet, summary information should be transferred to AIA Document G702, Application and Certificate for Payment. The Contractor should sign G702, have it notarized, and submit it, together with G703, to the Architect. The Architect should review G702 and G703 and, if they are acceptable, complete the Architect' s Certificate for Payment on G702. The Architect may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A201 . The Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 and G703 should be forwarded to the Owner. MAKING PAYMENT The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA Document G702, Application and Certificate for Payment. The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. EXECUTION OF THE DOCUMENT Persons executing the document should indicate the capacity in which they are acting (i.e., president, secretary, partner, etc . ) and the authority under which they are executing the document. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the firm or entity should be attached. AIA Document G702T" - 1992. Copyright © 1953, 1963, 1965 , 1971 , 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale 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. CHANGE ORDER Distribution to : AIA DOCUMENT G701 OWNER ARCHITECT CONTRACTOR FIELD OTHER PROJECT: CHANGE ORDER NUMBER: 5 I . R.C . Fire Station 95 6585 U . S. Highway I Vero Beach, FL 32967 INITIATION DATE: 10/ 11 /07 TO (Cortractor): r -I ARCHITECT' S PROJECT NO : Barth Construction, Inc . 1717 Indian River Blvd. CONTRACT FOR : Suite 202A L Vero Beach, FL 32960 J CONTRACT DATE: You are directed to make the following changes in this Contract: Owner Direct Purchase From 4/2107- 10/ 1 /07. See Attached. P.O. Balance Tax Total IRC P.O . a 00041273-00 Hughes Plumbing Supply $54.00 $3 .59 $57.59 Total of Change Order $57.59 Not valid until signed bV both the Architect and Owner. Signature oCthe Contractor indicates his agreement herewith, including any adjustment in the Contract Sum or Contract Time The Original ( Contract Sum) (Gaafanteed Maximum Cost) was . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2, 143,518.00 Net change by previously authorized Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -$ 242,995 . 13 The (Contract Sum) (Guaranteed Maximum Ces4) prior to this Change Order was . . . . . . . . . . . . $ 1 ,900,522. 87 The (Contract Sum) (Guaranteed Maximum CosO will be (iasfeasedj (decreased) (Hfl d) bythis Change Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. -$ 57.59 The new (Contract Sum) (G .ar- teed P 4wimm nt Cost` including this Change Order will be $ 1 ,900,465 .28 The Contract Time will be 'inefeased) (decreased) (unchanged) by ( ) Days The Date of Substantial Completion as of the date of this Change Order therefore is ARCHITECT CONTRACTOR OWNER Edlund, Dritenbas, Binkley, Arch . Barth Construction Indian River County Dept. of Emer. 65 Rove ! Palm Blvd., Suite D 1717 Indian River Blvd. 1840 25'' Street Vero Beach, F1 . 32960 Suite 202A Vero Beach, FL 32960 Vero Beach, FL 32960 BY: 0 0 7 DATE : A 6 1t 6 DATE : I Q6 AIA DOCt; MEN T G701 ' HANGSORDER APRII . 1978 EDITION " AIA ` 1978 THE AMERICAN INSTITt,TE OF ARC] IITECTS, 1735 NEW YORK AVE_, N.W., WASHINGTON, D.C. 20006 _ AWIVAI Document G703TM - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached . APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. OCT 11 ,2007 Use Column I on Contracts where variable retainage Cor line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A B C D E F G H I WORKCOMPLETED MATERIALS TOTAL SCHEDULED FROM PREVIOUS PRESENTLYCOMPLETED RETAINABLE ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED EDBALANCE AND STORED (G + TO C) FINISH ( F VARIABLE NO. (NOT IN TO DATE RATE) (D + E) DOR E) (D+E+F) (C - G) GENERAL CONDITIONS 28 FIELD SUPERVISION 1295000.00 74,634 .85 39234. 16 0.00 77,869.01 60.4 5L130.99 0.00 29 PROJECT MANAGEMENT 865000 .00 595931 .74 4,344.56 0.00 64,276.30 74.7 215723 .70 0.00 34 PERMANENTPOWER 2,500.00 225 .27 0.00 0.00 225 .27 9 .0 25274 .73 0.00 36 TRAILER RENTAL 21,800.00 2,735 .63 0.00 0.00 21735 .63 97. 7 64. 37 0.00 40 TEMP. POWER ' 1 ,200.00 0.00 0.00 0.00 0.00 0.0 11200.00 0.00 42 TELEPHONE 1 ,600 .00 989. 10 18 .99- 0.00 970. 11 60.6 629.89 0.00 44 TEMPORARY TOILET 1 ,600.00 878. 83 295.08 0.00 15173 .91 73 .4 426.09 0.00 50 PROJECT SIGN 1 ,000.00 549.97 0.00 0 .00 549.97 55 .0 450.03 0.00 52 TEMPORARY FENCE 41,500.00 2,973 . 56 0.00 0.00 21973 .56 66. 1 1 ,526.44 0.00 54 FIELD OFFICE SUPPLIES 125 .00 0.00 0.00 0.00 0.00 0.0 125 .00 0.00 58 TEMP. PROTECTION 2,000.00 1 , 146.64 0.00 0.00 17146.64 57.3 853 .36 0.00 68 FIRSTAID 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 55000.00 11794.06 170.04 0.00 13964. 10 39. 3 31035 .90 0.00 74 PHOTOGRAPHY 150.00 0.00 0.00 0.00 0.00 0.0 150.00 0.00 77 ARCHITECTURAL FEES 49, 191 .00 485326.60 364.38 0.00 48,690.98 99.0 500.02 0.00 78 ENGINEERING 18,225 .00 17,475 .00 750.00 0.00 18,225 .00 100.0 0.00 0.00 80 SOIL TESTING 2,500 .00 31210.00 0.00 0.00 3 ,210.00 128.4 710.00- 0.00 82 CONCRETE TESTING 2,200 .00 997. 50 0.00 0.00 997.50 45 .3 ' 1 ,202 .50 0.00 88 SM. TOOL/SUPPLIES 3 ,800.00 2,236.45 198. 88 0.00 25435 .33 64. 1 11364.67 0.00 92 HOUSEKEEPING LABOR 41750.00 23665 . 56 0.00 0.00 2,665 .56 56. 1 2,084 .44 0.00 94 FINAL CLEANING 2,400.00 11797.60 0.00 0.00 1,797.60 74.9 602 .40 0.00 1 .10 SOLID WASTE FEE 500.00 0 .00 0.00 0.00 0.00 0.0 500.00 0 .00 1 121 341 00 112 56R 36 9. 119 11 0.00 231 90647 - 89434 51 (100 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 G703TM - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAx 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. U011 AIA Document G703T" - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702.. Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia,org or a local AIA component to verify the most recent edition . Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page . Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column . Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought, The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column . Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period.) Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form . Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. ,A AT C D L A% "PK coBmLETEo HAITRIALS Io1HL DAL %NCE kIIF VRYlYR fLY CO IYLLILD .FPIAIVAGE ITEM t( D FROM PHI VIOLS 4 TO NO D6CRII'I1040F WORK V1I 11pPl if A'I IOS lHl$ YLHIOD STORE D 4VDtilOHEI] ,p_CI I1M1f5II ,IFFARE ABLE ,NOT Fi TO nAIE 21TL, ,D + EI t OORFI 'D+GF ,C -C MOBILRATION 5000 soon 0 0 5000 100 0 2 STUMP REMOVAL 5000 5000 0 0 5000 100 0 3 EARTH WORK 15,000 10000 5000 0 15 ISO 100 0 4 LOWER RETAINING WALL 10000 C 5000 0 5000 50 5000 5 CURBS d Wl CONC. 5,000 e 0 0 0 0 5000 6 PAVING,. UPPER DRIVE 20,000 .. 0 0 0 0 20000 7 PAVING, LOWER DRIVE 20000 0 0 0 0 0 20000 8 FAVER5 20000 0 1 10,000 10000 50 1n Ano 9 BRICKWORK 5000 0 1 0 c 0 5000 10 11 105000 20,000 10000 10000 40,000 65,000 AIA Document G703TM - 1992. Copyright 01963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAD Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIAR 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.cm 1011012007 Indian River County , Fire Station #5 - Direct Purchase Log Bealnudinit Balance Current Previous Owner CO Cost Sub. Add. Date Vendor P.O. Amt Tax P.O. + Tax Current Sales Current Prev Sales Total Remain P.O, Issued Code Issued P.O. # Issued Real. # Material Supplier) Subcontractor (Net $) . Savings $ Amount Inv Tax Total Inv4d Tax Inv Balance E 1 11450 Atld. 1 00041145-00 6/1 /06 2624 Statewide LaundryEquip Statewide LaundryEquip 5,120.00 358.40 5,478.40 $0.00 $000 5,12000 $358.40 $5,478.40 $0.00 _ 1 _ 6050 Add. 1 00041139-00 6/1 /06 2621 Stock Components Stock Components 22,100.00 1 ,376.00 23,476.00 $0.00 $0.00 22,10000 $1 ,378.00 $23,476.00 $0.00 _1 11600 Add. 1 00041141 -00 6/1 /06 2622 Mid-Minnesota Wire Mid-Minnesota Wire 8,498.00 559.88 9,057.88 $0.00 $000 8,49800 $559.88 $9,05788 $0.00 _ 1 8103 Add. 1 00041143-00 611 /06 2623 Doarwa Corporation Doorwa Corsoration 39,40000 2,414.00 41 ,814.00 $0.00 $0.00 39,40000 $2,414.00 $41 ,814.00 $0.00 _1 11450 Add. 1 00041255-00 6/20/06 2775 Designs, Furn & E ui Designs, Furn & Equip 7,660.00 50900 8,169.00 $0.00 $0 00 7,660.00 $50900 $8,16900 $0.00 _�_... 1 15801 Atld. 1 00041254-00 _6/20/06 2774 Designs, Furn 8 Equip Designs Furn 8 Equip 12,120.00 777.20 12,897.20 $0.00 $0.00 12,120.00 $777.20 $$2,897.20 $0.00 1 15400 Atld. 1 00041273-00 6122106 2790 Hughes Plumbing Supply, Ltd. Southern Plumbing 7,221 .38 478.99 7,700.37 0.00 $0.00 $0.00 2,027.70 $134.50 $2162.20 5193.68 4 _15400 Add. 2 00041273.00 7/25107 Reverse Balance on PO Southern Plumbing -5,247.68 -348.08 -5,595.76 -$5,247.68 5 Correct Balance reversed 54.00 3.59 57.59 $54.00 1 _ 16003 Add. 1 00041272.00 6122/06 _ 2789 TAW Power Sy stems Complete Electnc 3400000 2.09000 36,09000 $000 $0.00 34,000.00 $2,090.00 $36,090.00 $0.00 1 - 2000 Adtl_1 00041251 -00 6/20/06 _ . 2776 ABS Pumps, Inc_ _ Cathco 17,790.00 1,09240 1888240 $000 $0.00 17,79000 $1 ,09240 $18882.40 $0.00 1 _ 9015 Add -1 00041294-00 8/27/06 _281_7 SeacoastSupply _ _ Florida Preferred Contractors 9,439.25 66075 1010000 $0.00 $0.00 6,791 .65 $47542 $7267.07 $2,647.60 4 9015 Atld. 6 00041294-00 7125107 Reverse Balance an PO Florida Preferred Contractors -2,647.60 -185.33 -2,832.93 -$2.647.60 2 11450 - 00041496-00 8/2106 3082 Designs, Tum & E ui . Desi ng s, Furn & Equip940.00 65.80 1005.80 $0.00 $000 94000 $6580 $1 ,00580 $0.00 _ 2 _ 6000 - 00041679-00 _ 916/063327 Stock Building Supply _ Stock Building Supply 15,538.12 1 ,087.68 16,625.80 $000 $000 15,51487 $1 ,086.05 $16,600.92 $23.25 4 6000 00041679-00 7/25/07 Reverse Balance on PO Stock Building Supply -2335 -1 .63 -24.88 $0.00 $0.00 -$23.25 2 16000 At i 00041725-00 9/13/08 3374 Rexel Southern Complete Electric 32,890.00 2302.30 35192.30 $000 $000 3268376 $2,287.86 $34,97162 $206.24 4 16000 Add, 5 00041725.00 7/25/07 Reverse Balance on PO Complete Electric -206.24 -14.44 -220.68 $0.00 $0.00 -$206.24 3 15600 Ati 00043597-00 10/9/06 771 Trane Company Barker Air Conditioning 13,97100 888.26 14,859.26 Cancelled $0.00 $0.00 0.00 $0.00 $0.00 Cancelled 4 Reverse Balance on PO .13 971 .00 488.26 -14,859.26 3 15800 Add. 2 00043588-00 10/6/06 782 Baker Drstributino Co. Barker Air Conditionina 9,41200 614.72 10,026.72 $0.00 $0.00 9,41200 $614.72 $10,026.72 $0.00 3 15800 Add, 3 00043602-00 1 10/9106 1 769 Tom Bartow Co. Barker Air Conditioning 2,161 .00 151 .27 2,312.27 Cancelled $000 $0.00 0.00J$888.26 $000 Cancelled 4 Reverse Balance on PO -2161 .00 -161 .27 -2 312.27 4 00044442-00 1 /24/07 1658 Statewide LaundryEquip Statewide LaundryEquip 27500 19.25 294.25 $000 $0.00 275.00 $29425 $0.00 4 15600 Add. 6 00044835-00 4/2107 2164 Barker Air Condidionin Barker Air Conditioning13,971 .00 888.26 14,859.26 $0.00 $0.00 13,971 .00 $14,85926 $0.00 $000 $000 $000 $000 Totals To Date 228,303.98 14,74874 243052.72 $0.00 $000 $0.00 $22830399 $ , $243,052.72 $0.00 - T _:�_:= W=vIA Document G703TM - 1992 Continuation Sheet AIA Document ( 3702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT 11 ,2007 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A B C D 177 E F G H WORK COMPLETED MATERIALS 'COT'AL PRESENTLY COMPLETED BALANCE RETAINAGE ITEM DESCRIPTION OF WORK STORED SCHEDULED FROM PREVIOUS %, TO (IF VARIABLE SAND STORED NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (C + C) FINISH RATE) (D + E) UORE) (D+E+F) (CG) 118 SURVEYING 10,000.00 10,950. 15 2,358.90 0.00 13,309.05 133 . 1 3 ,309.05- 0.00 124 COMMON LABOR 41750.00 31707.30 0.00 0.00 3,707.30 78.0 1 ,042 .70 0.00 126 DUMP CHARGES 12,000.00 61522.60 606.70 0.00 7, 129.30 59.4 4,870.70 0.00 140 PUNCH-OUT LABOR 700.00 0.00 0.00 0.00 0.00 0.0 700.00 0.00 144 BUILDERS RISK 9,000.00 71929.00 0.00 0.00 7,929.00 88. 1 1 ,071 .00 0.00 148 LIABILITY INSURANCE 2,800.00 2,800.00 0.00 0.00 2,800.00 100.0 0.00 0.00 150 CONTINGENCY 50,000.00 32,502.51 21330.95 0.00 34,833 .46 69.7 15, 166. 54 0.00 152 BUILDING PERMIT 67750.00 35186. 11 360.78 0.00 39546.89 52 .5 3,203 . 11 0.00 156 G.C . BOND 15 ,500.00 14,854.00 0.00 0.00 ' ' 143854.00 95. 8 646.00 0.00 164ASBESTOS ABATEMENT 2,750.00 3 ,325 .00 0.00 0.00 3 ,325 .00 120.9 575 .00- 0.00 SITE WORK 168 SITE DELEVOPMENT 258,086.00 258,086.00 0.00 0.00 258,086.00 100.0 0.00 0.00 176 DEMOLITION 15 ,000.00 13 ,500.00 0.00 0.00 13 ,500.00 90.0 1 ,500. 00 0.00 180 GREASE TRAP/D.F. 3 ,000.00 39970. 50 0.00 0.00 3,970.50 132 .4 970. 50- 0.00 188 ERROSION CONTROL 1 ,500.00 1 ,693 .64 0.00 0.00 11693 .64 112.9 193 .64- 0.00 250 LANDSCAPING 55,000.00 47,220.00 18,530.75 0.00 65,750.75 119.5 10,750.75- 0.00 262 FENCING 9,855 .00 81422.00 0.00 0.00 89422 .00 85 .5 15433 .00 0.00 CONCRETE 274 CONCRETE SUB-CONTR 263, 100.00 266, 143 .50 11200.00 0.00 267,343 . 50 101.6 49243 . 50- 0.00 MASONRY 328 MASONRY SUB-CONTR. 6,000.00 31267 .45 0.00 0.00 35267.45 54.5 2,732 .55 0.00 356 MASONRY INSULATION 21500.00 2,377.00 0.00 0.00 2,377.00 95. 1 123 .00 0.00 METALS l 368 MISC. METALS 5,550.00 5,550.00 0 .00 0.00 5,550.00 100.0 0.00 0.00 733P841100 696,006.76 25,388 .08 0.00 721 ,394. 84 12,446. 16 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 G703TM - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 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, copyrightibaia.org. =-- AIA Document G703TM - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.ala.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703 , but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel , copyright@aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C : These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required . Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application.. including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period.) Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H : Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date) . Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A 9 C D E 1' C H I KORH (DMVLC I LU MATEM %TS TOTALL 84L>N PkE$F ViIV COUP( FTFD RC (AIA pGC ITEM SCAALLI FO PRFVTOI 4- 10 DF_SCRIYI IOV 01' WORk _ STORED AND STORED 111 RA 11 LG VO. VdLCE 4P LiCATIO� THIS PFFIOO YIVItiH NOT OR E) TO DI Ril Cl D - e, noR CI ,o-s.E, l 1 MOBILIZATION 5000 5000 .. 0 5000 100 0 2 STUMP REMOVAL 5,000 5000 0 0 5,000 130 0 3 EARTH WORK 15000 Iewo 5000 0 15000 100 0 4 LOWER RETAINING WALL iD 000 0 5000 0 5000 50 5,000 5 CURBS b MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000 R (AVERS 20000 0 0 10000 imox 53 10,000 9 BRICK WORK 50W 0 0 0 0 0 5,000 10 I n c5000 28000 1 10,000 10,000 1 40000 Il can AIA Document G703TM' - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978: 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAn 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. copyrightCaIaia.org. CHANGE ORDER Distribution to: AIA DOCUMENT G701 OWNER ARCHITECT CONTRACTOR _ FIELD _ OTHER PROJECT: CHANGE ORDER NUMBER: 6 I.R.C . Fire Station 45 6585 U.S . Highway 1 Vero Beach, FL 32967 INITIATION DATE: 10/ 11 /07 TO (Contractor): I— 1 ARCHITECT' S PROJECT NO: Barth Construction, Inc. 1717 Indian River Blvd. CONTRACT FOR: Suite 202A L Vero Beach, FL 32960 J CONTRACT DATE: You are directed to make the following changes in this Contract: Final Cost of Construction (Including Contractor' s Fee) $ 108,702 .90 Less Current Contract Amount <$ 11900,465 .28> Change Order Amount <$91,762.38> Not valid until signed by both the Architect and Owner. Signature of the Contractor indicates his agreement herewith, including any adjustment in the Contract Sum or Contract Time The Original (Contract Sum) (GuaF Meed n,r...,:..,um Cost) was . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . $2, 143,518.00 Net change by previously authorized Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -$ 243,052.72 The (Contract Sum) prior to this Change Order was . . . . . . . . . . . . $ 1 ,900,465 .28 The (Contract Sum) (GaaFmteed " a. � :.. um Cost) will be (iasreased) (decreased) (utiehanged) by this Change Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. -$ 91 ,762.38 The new (Contract Sum) including this Change Order will be $ 1 ,808,702.90 The Contract Time will be (inereased) (decreased) (unchanged) by ( ) Days The Date of Substantial Completion as of the date of this Change Order therefore is ARCHITECT CONTRACTOR OWNER Edlund, Dritenbas, Binkley, Arch. Barth Construction Indian River County Dept. of Emer. 65 Royal Palm Blvd., Suite D 1717 Indian River Blvd. 1840 25" Street 4 • , Vero Beach, FL 32960 Suite 202A Vera Rgacb, FL320,6(!t , AUL U • Visit Vero Beach, FL 32960 DATE: rC Zeo oaf� f�� DATE AIA DOCUMENT G701 * .RANGE ORDER * APRIL 1978 EDITION * AIA * 1978 THE AMERICAN INSTITUTE F ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 S T =AIA Document G703tN - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT 11 ,2007 In tabulations below, amounts are staled to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A B C D E F G H f WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED E TO RETAINAGE ITEM DESCRIP"fION OF WORK STORED AND STORED (IP VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G + C) FINISH RATE) (D + E) DOR E) (D+E+F) (C - G) 382 SHUTTERS/AWNINGS 6,307.00 6,306.59 0.00 0.00 6,306.59 100.0 0.41 0.00 394 PIPE BUMBERS 750.00 605 .48 0.00 0.00 605 .48 80.7 144.52 0.00 CARPENTRY 402 WOOD & LUMBER 28,500.00 27,846.97 19261 .55- 0.00 26,585 .42 93 .3 1 ,914.58 0.00 412 TRUSSES 25,000.00 25,433 .61 1 ,957 .61 - 0.00 23,476.00 93 .9 1 ,524.00 0.00 414 ROUGH CARPENTRY 64,600.00 65,357.00 0 .00 0.00 65,357.00 101 .2 757.00- 0.00 494 STAINLESS TOPS 6,500.00 6,325 .20 0.00 0.00 6,325 .20 97.3 174. 80 0.00 THERMAL/MOISTURE 502 CAULKING 4,000.00 54.00 0.00 0.00 54.00 1 .4 31946.00 0.00 504 INSULATION 5,850.00 5,824.00 0.00 0.00 5,824.00 99.6 26.00 0.00 514 ROOFING S.C . 27,800.00 32,600.00 0.00 0.00 327600.00 117.3 4,800.00- 0.00 524 GUTTERS/D. S. 0.00 23819.00 0.00 0.00 27819.00 0.0 2,819.00- 0.00 DOORS AND WINDOWS 550 H.M. DOOR - LABOR 51000.00 41000.00 0.00 0.00 43000.00 80.0 13000.00 0.00 552 H.M ./WOOD/HDW PKG 42,500.00 48,766.00 0.00 0.00 48,766.00 114.7 61266.00- 0.00 562 OVERHEAD DOORS 165500.00 15,730.40 0.00 0.00 15,730.40 95 .3 769.60 0.00 578 WINDOWS,GLASS & GLAZINC 11 ,275 .00 11 ,275 .00 0.00 0.00 115275 .00 100.0 0.00 0.00 FINISHES 604 STUCCO 365805 .00 41 ,892 .07 2,832 .93 0.00 44,725 .00 121 .5 7,920.00- 0.00 606 DRYWALL 61 ,000 .00 60,300.00 0.00 0.00 60,300.00 98.9 700.00 0.00 610 TILE/MARBLE 28,201 .00 28,201 .00 0.00 0.00 28,201 .00 100.0 0.00 0.00 622 ACOUSTIC CEILING 10,000.00 91370.00 0.00 0.00 97370.00 93 . 7 630.00 0.00 638 PAINTING 35,000.00 34,220.00 0.00 0.00 34,220.00 97. 8 780.00 0.00 415 ,588.00 426,926.32 386.23 - 0.00 426,540.09 10,952.09- 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 G7(l - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING : This AIA00Document 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 ter If 0) 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. = I Document G703TM Instructions A Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered In AIA Document A201 . General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia .org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C : These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required . Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application , including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F : Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column , Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period .) Column G : Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form . Construction Change Directives : Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of Continuation Sheet for work in progress, Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A P C D _ C (3 H 1 K KCORI DRPI FT' D A1TTFRIAl I(Y1AL 9 Al AVCE 9CFI6DUIliD FROy VRL'IOiS pRFSFN-fIV COl1YLLILD RF IAIFAGL IILM C DECRIIT0AOFAORK STORED ANO � I (1BGD JYIARIABLL VO. VALUF APPI I( AIION THIS PERIOD iG-L FVTO AH � naT In TO onrr. R.vr; m- Pi DORe) (D -F, K-ei 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5000 5000 0 5,000 100 0 3 EARTH WORK 15000 11 5,000 0 15000 100 0 4 LOWER RETAINING WALL 10 C00 C 5,000 0 5,000 50 5000 5 CURBS A MISc. cow 5000 0 0 0 0 0 5.000 6 PAVING, UPPER DRIVE 20000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 2exo 0 1 0 0 C 0 20,000 B PAVERS 20,ODo 0 0 10,000 10000 50 10000 9 BRICK WORK 5,000 1 0 0 0 0 0 5,000 10 11 105111 20000 10000 10000 40,000 65000 AIA Document G711992. Copyright © 1963, 1965, 1966. 1967.. 1970, 1978, 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 Architectslegal counsel, copyright@aia.org. V.:AIA Document G702TM - 1992 Application and Certificate for Payment TO OWNER: PRR JECT: IRC FIRE STA #5 - PART 2 APPLICATION N0: INDIAN RIVER COUNTY l8� Distribution to: 1840 25TH STREET 6586 US 1 PERIOD TO: 09/30/07 OWNER VERO BEACH, FL 32960 WABASSO, FL 32967 184 CONTRACT FOR: ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 06/01 /06 BARTH CONSTRUCTION, INC. EDLUND & DRITENBAS ARCH. P.A . CONTRACTOR ❑ 1717 INDIAN RIVER BLVD., SUITE 202A 65 ROYAL PALM BLVD., S. D PROJECT NOS: ❑ VERO BEACH, FL 32960 VERO BEACH , FL 32960 FIELD OTHER ❑ CONTRACTOR' S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractor' s knowledge, information Application is made for payment, as shown below, in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet, AIA Document G703, is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 2, 143 ,51 00 which previous Certificates for Payment were issued and payments received Irom the Owner, and 1 . ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ $ that current ay own herein is now due. 2. Net change by Change Orders . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . $ '334,8151 CONTRA OR: 3. CONTRACT SUM TO DATE (Line I t 2) . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... . .. $ 1 ,808,702 .90 By: Date: �d it o 4. TOTAL COMPLETED & STORED TO DATE (Column G on 6703) . . . . . . $ 1 ,808,702 .90 St f: ' ���f-� 5. RETAINAGE: my of: � / � a• % of Completed Work (Column D + Eon G703) $ ubscribed and sworn to before methis li day oft)Cj� oqi b• vin of Stored Material //// �e� 'qk Marion H Tupek L - - r+tr Commisabn DD339676 (Column F on G703) $ Notary Public : �— g l / Aptidr Expires July 2i , 2006 Total Retainage (Lincs Sa + 56 or Total in Column T of G703) . . . . . . . $ 0.00 My Commission expires: 9 �Zi /� 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 118083702.90 ARCHITECT' S CERTIFICATE FOR PAYMENT (Linc 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 . . . . . . . . . . . . . . . . . . . . . . $ 15773 ,564.91 this application, the Architect certifies to the Owner that to the best of the Architect' s knowledge, (Line 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 the 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35, 137.99 AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED . . . . . . .. . .. .. .. . .. .. . . ..... . . ... . . .. . ... . . .:. . ... ... ... .. .. . $ 1l�; �� 7 1 . .... . .. . . ... . ... . (Linc 3 less Line 6) $ 0.00 (Attach e,rp[ana' amount red diff"ers fi orrt the amount applied. Initial a12,('tgure.c oil this Appheatioa an on r e anti ua an Shect Khat fire changed to con/orm with the amount certified j CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT• Total changes approved in previous months by Owner $ 0.00 $ 253 ,687.40 12 �T 7,e.'t�� BY: Date: Total approved this Month $ 10,692 .27 $ 91 ,819.97 9 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 10,692 .27 $ 345,507.37 named herein . Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ -334, 815 . 10 the Owner or Contractor under this Contract 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 G7027e — 1992. Copyright © 1953, 1963, 1965, 1971 , 1978, 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 AIAO 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. - T = : I Document G703TN - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT It 52007 In tabulations below, amounts are stated to the nearest dollar. SEP 30,2007 Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: ARCHITECT'S PROJECT NO: 184 A B C D E F G H WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RFARIAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS % ICI (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD STORED AND STORED(NOT IN TO DATE (G . Q FINISH RATE) (D + E) D OR E) (D+E+F) (C - (i) SPECIALTIES 666 TOILET PARTITIONS 4, 155 .00 55585 .00 0.00 0.00 5,585.00 134.4 1 ,430.00- 0.00 673 FLAGPOLE 25010.00 19573 .25 0.00 0.00 15573 .25 78 .3 436.75 0.00 675 1DENT. DEVICES-MAT. 31,050.00 15570.97 0.00 0.00 1 ,570.97 51.5 11479.03 0.00 685 METAL SHELVING 1 ,000.00 426.72 0.00 0.00 426.72 42.7 573 .28 0.00 686 BATH ACC.-MAT:. 4,065 .00 31,502. 74 0.00 0.00 31502.74 86.2 562.26 0.00 689 CULTURED MARBLE 85100.00 71779.34 0.00 0.00 7,779.34 96.0 320.66 0.00 714 RESIDENTIAL ADPL. 15 ,900.00 15,553 . 59 294 .25 0.00 15 ,847.84 99.7 52. 16 0.00 723 GEAR HOSE & LOCKER ACCE S 11 ,498 .00 10,057. 88 0.00 0.00 10,057.88 87.5 1 ,440. 12 0.00 742 CASEWORK 34,264.00 34,264.38 0 .00 0.00 349264.38 100.0 0. 38- 0.00 MECHANICAL 785 PLUMBING 31 ,280.00 35,939.30 54.00 0.00 35,993 .30 115 . 1 4,713 .30- 0.00 788 SPRINKLER SYSTEM 55,000.00 54,800.00 0.00 0.00 54,800.00 99.6 200. 00 0.00 793 HVAC 104,457 .00 102,885 .00 0.00 0.00 102,885 .00 98 .5 1 ,572.00 0.00 800 KITCHEN HOOD 131,000.00 13,084.45 0.00 0.00 13,084 .45 100.6 84.45- 0.00 803 L/P TANK 81000.00 6,041 .07 496. 50 0.00 6,537.57 81 .7 1 ,462 .43 0.00 ELECTRICAL 811 ELECTRICAL S .C. 148,400.00 149,255 .25 301 . 53 0.00 149,556.78 100.8 11156.78- 0.00 827 GENERATORS 385500.00 385380.00 0.00 0.00 38,380.00 99.7 120.00 0.00 901 CONSTRUCTION FEE 190,069.00 190,069.00 0.00 0.00 1901,069.00 100.0 0.00 0.00 0001 CO # 1 173 ,665 .25- 165 ,240. 15- 81425 . 10- 0.00 173,665 .25 100.0 0.00 0.00 0002 CO #2 52,823 .90- 52,578. 34- 245 . 56- 0.00 52,823 .90 100.0 0.00 0.00 0003 CO #3 27, 198 .25- 245885 .98- 2,312 .27- 0.00 27, 198.25- 100.0 0.00 0.00 0004 CO 94 10,692 .27 0.00 1Q692 .27 0.00 10,692.27 100.0 0.00 0 .00 429,752 . 87 428,063 .47 855 .62 0.00 428,919.09 833 .78 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, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale 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. T I Document G703TM - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment., is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software, Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia .org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page . Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column . Column E : Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column . Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period. ) Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule . The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A 9 C F G H WORK C WiPLETED M TY.RIAIS IJ1I L B�ANCE PRPlF\TIY COl1YLLIEO REIAIFAGE ITEM SCRFOIII FD FROM PR F V IOLS 9 TO \O OLSCRIPn060FWORK V OF \PI'I I( \ 1106 IIHIS YLRIOD SNOT IN ANO DA I <1 -1 IC G , IF Vg21ABLE i o IN l01>A IL IUTE) 10- Ei !> OR EI N+li-FI IC G , 1 M061LIZATION 15,000 5,000 0 0 5000 100 0 2 STUMP REMOVAL 15,000 500C 0 0 5000 100 0 3 EARTH WORK 15,000 10,000 5.002 0 15,000 100 0 4 LOWER RETAININ6 WALL IOOoo 0 5,000 0 500 5o 5,000 5 CURBS d MItto cow 5000 o C 0 C 0 5,000 6 PAVING, UPPER DRIVE 20000 0 0 0 0 0 20000 7 PAVING, LOWER DRIVE 20,000 0 0 0 C 0 20,000 9 PAVERS 20000 0 C to Coo 10000 50 10,000 9 BRICK WORK 5,000 0 C 0 0 0 5,000 10 it 105000 20,000 10000 10,000 40,000 650G0 AIA Document G703TM — 1992. Copyright © 1963, 1965, 1966, 1967, 1970.. 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIAO 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, copyrightpa aia.org. _AIADocument G702r°" - 1992 Instructions Application and Certificate for Payment GENERAL INFORMATION Purpose and Related Documents AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA . Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement ITULA) . To report copyright violations of AIA Contract Documents , e-mail The American Institute of Architects' legal counsel, copyright@aia.org. COMPLETING THE G702 FORM After the Contractor has completed AIA Document G703 , Continuation Sheet, summary information should be transferred to AIA Document G702, Application and Certificate for Payment. The Contractor should sign G702, have it notarized, and submit it, together with G703, to the Architect. The Architect should review G702 and G703 and, if they are acceptable, complete the Architect' s Certificate for Payment on G702. The Architect may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A201 . The Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 and G703 should be forwarded to the Owner. MAKING PAYMENT The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA Document G702, Application and Certificate for Payment. The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. EXECUTION OF THE DOCUMENT Persons executing the document should indicate the capacity in which they are acting (i.e., president, secretary, partner, etc . ) and the authority under which they are executing the document. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the firm or entity should be attached. AIA Document G702T" - 1992. Copyright © 1953, 1963, 1965 , 1971 , 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale 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. _ AWIVAI Document G703TM - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached . APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. OCT 11 ,2007 Use Column I on Contracts where variable retainage Cor line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A B C D E F G H I WORKCOMPLETED MATERIALS TOTAL SCHEDULED FROM PREVIOUS PRESENTLYCOMPLETED RETAINABLE ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED EDBALANCE AND STORED (G + TO C) FINISH ( F VARIABLE NO. (NOT IN TO DATE RATE) (D + E) DOR E) (D+E+F) (C - G) GENERAL CONDITIONS 28 FIELD SUPERVISION 1295000.00 74,634 .85 39234. 16 0.00 77,869.01 60.4 5L130.99 0.00 29 PROJECT MANAGEMENT 865000 .00 595931 .74 4,344.56 0.00 64,276.30 74.7 215723 .70 0.00 34 PERMANENTPOWER 2,500.00 225 .27 0.00 0.00 225 .27 9 .0 25274 .73 0.00 36 TRAILER RENTAL 21,800.00 2,735 .63 0.00 0.00 21735 .63 97. 7 64. 37 0.00 40 TEMP. POWER ' 1 ,200.00 0.00 0.00 0.00 0.00 0.0 11200.00 0.00 42 TELEPHONE 1 ,600 .00 989. 10 18 .99- 0.00 970. 11 60.6 629.89 0.00 44 TEMPORARY TOILET 1 ,600.00 878. 83 295.08 0.00 15173 .91 73 .4 426.09 0.00 50 PROJECT SIGN 1 ,000.00 549.97 0.00 0 .00 549.97 55 .0 450.03 0.00 52 TEMPORARY FENCE 41,500.00 2,973 . 56 0.00 0.00 21973 .56 66. 1 1 ,526.44 0.00 54 FIELD OFFICE SUPPLIES 125 .00 0.00 0.00 0.00 0.00 0.0 125 .00 0.00 58 TEMP. PROTECTION 2,000.00 1 , 146.64 0.00 0.00 17146.64 57.3 853 .36 0.00 68 FIRSTAID 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 55000.00 11794.06 170.04 0.00 13964. 10 39. 3 31035 .90 0.00 74 PHOTOGRAPHY 150.00 0.00 0.00 0.00 0.00 0.0 150.00 0.00 77 ARCHITECTURAL FEES 49, 191 .00 485326.60 364.38 0.00 48,690.98 99.0 500.02 0.00 78 ENGINEERING 18,225 .00 17,475 .00 750.00 0.00 18,225 .00 100.0 0.00 0.00 80 SOIL TESTING 2,500 .00 31210.00 0.00 0.00 3 ,210.00 128.4 710.00- 0.00 82 CONCRETE TESTING 2,200 .00 997. 50 0.00 0.00 997.50 45 .3 ' 1 ,202 .50 0.00 88 SM. TOOL/SUPPLIES 3 ,800.00 2,236.45 198. 88 0.00 25435 .33 64. 1 11364.67 0.00 92 HOUSEKEEPING LABOR 41750.00 23665 . 56 0.00 0.00 2,665 .56 56. 1 2,084 .44 0.00 94 FINAL CLEANING 2,400.00 11797.60 0.00 0.00 1,797.60 74.9 602 .40 0.00 1 .10 SOLID WASTE FEE 500.00 0 .00 0.00 0.00 0.00 0.0 500.00 0 .00 1 121 341 00 112 56R 36 9. 119 11 0.00 231 90647 - 89434 51 (100 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 G703TM - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAx 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. _ =� = IA Document G703tN — 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT 11 ,2007 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A R C U E F G H WORK COMPLETED MATERIALS TOTAL PRESENTLY COMPLETED BALANCE SCHEDULED FROM PREVIOUS % RETAINAGE ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED AND STORP.D (G = C) FINISH (IFVARIABLF. NO. (NOT IN TO DATE (C G) RATE) (U + E) D OR E) (D+E+F) 000.5 CO #5 57. 59- 0.00 57 .59- 0.00 57.59- 100.0 0.00 0.00 0006 CO #6 919762.38- 0.00 0.00 0.00 0.00 0.0 91 ,762.38- 0.00 108,702.90 1 ,773 ,564.91 35 , 137 .99 0.00 1 ,808,702 .90 100.0 0.00 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 G703Tu — 1992. CopyrightQ) 1963, 1965, 1966, 1967, 1970, 1978, 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. =AI Document G703TM1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702 , Application and Certificate for Payment, is to be used In conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction . Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel , copyright@aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A. B & C : These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted . The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum . The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column . Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated In the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period . This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period.) Column G Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H : Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form . Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders, Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A a O WORK COMR£rED MATERIALS TOTAL 5iL AVCF IT EA1 SCHEDULED FROM Pli 1015 PRE6ENTIY COMPLETED q TO RFI4IAAGE NO DF_SCNILLION OFNF IAti ORK yALIAPPLICATION PERIOD STORED ANDlE + IFRED 'IFS ARIA3LL: (NOT IN 10DAIL f ( IC G]) BATF, `D + G IC DORE� iD+PwI^, - G 1 MOBILIZATION 5000 5000 0 0 5000 100 0 2 5TUMP REMOVAL 5,000 5000 0 0 5000 Ion 0 3 EARTH WORK 25,000 10000 5000 0 15,000 100 0 4 LOWER RETAINING WALL 10000 0 5000 0 5000 50 5,000 5 CWR56 MISC. CONC 5000 0 0 0 0 0 5000 6 PAVING. WPER CALVE 20000 0 0 0 0 0 20000 7 PAVING, LOWER DRIVE 20,000 0 0 0 v 0 20000 e FAVERS 20000 0 0 10000 10,000 50 10,000 9 BRICK WORK 5,00C 0 0 0 0 0 5,000 10 11 1 Oro 20000 10,030 10000 40000 65,000 AIA Document G703TM — 1992. Copyright © 1963, 1965. 1966, 1967, 1970, 1978, 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. U011 AIA Document G703T" - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702.. Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia,org or a local AIA component to verify the most recent edition . Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page . Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column . Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought, The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column . Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period.) Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form . Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. ,A AT C D L A% "PK coBmLETEo HAITRIALS Io1HL DAL %NCE kIIF VRYlYR fLY CO IYLLILD .FPIAIVAGE ITEM t( D FROM PHI VIOLS 4 TO NO D6CRII'I1040F WORK V1I 11pPl if A'I IOS lHl$ YLHIOD STORE D 4VDtilOHEI] ,p_CI I1M1f5II ,IFFARE ABLE ,NOT Fi TO nAIE 21TL, ,D + EI t OORFI 'D+GF ,C -C MOBILRATION 5000 soon 0 0 5000 100 0 2 STUMP REMOVAL 5000 5000 0 0 5000 100 0 3 EARTH WORK 15,000 10000 5000 0 15 ISO 100 0 4 LOWER RETAINING WALL 10000 C 5000 0 5000 50 5000 5 CURBS d Wl CONC. 5,000 e 0 0 0 0 5000 6 PAVING,. UPPER DRIVE 20,000 .. 0 0 0 0 20000 7 PAVING, LOWER DRIVE 20000 0 0 0 0 0 20000 8 FAVER5 20000 0 1 10,000 10000 50 1n Ano 9 BRICKWORK 5000 0 1 0 c 0 5000 10 11 105000 20,000 10000 10000 40,000 65,000 AIA Document G703TM - 1992. Copyright 01963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAD Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIAR 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.cm - T _:�_:= W=vIA Document G703TM - 1992 Continuation Sheet AIA Document ( 3702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT 11 ,2007 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A B C D 177 E F G H WORK COMPLETED MATERIALS 'COT'AL PRESENTLY COMPLETED BALANCE RETAINAGE ITEM DESCRIPTION OF WORK STORED SCHEDULED FROM PREVIOUS %, TO (IF VARIABLE SAND STORED NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (C + C) FINISH RATE) (D + E) UORE) (D+E+F) (CG) 118 SURVEYING 10,000.00 10,950. 15 2,358.90 0.00 13,309.05 133 . 1 3 ,309.05- 0.00 124 COMMON LABOR 41750.00 31707.30 0.00 0.00 3,707.30 78.0 1 ,042 .70 0.00 126 DUMP CHARGES 12,000.00 61522.60 606.70 0.00 7, 129.30 59.4 4,870.70 0.00 140 PUNCH-OUT LABOR 700.00 0.00 0.00 0.00 0.00 0.0 700.00 0.00 144 BUILDERS RISK 9,000.00 71929.00 0.00 0.00 7,929.00 88. 1 1 ,071 .00 0.00 148 LIABILITY INSURANCE 2,800.00 2,800.00 0.00 0.00 2,800.00 100.0 0.00 0.00 150 CONTINGENCY 50,000.00 32,502.51 21330.95 0.00 34,833 .46 69.7 15, 166. 54 0.00 152 BUILDING PERMIT 67750.00 35186. 11 360.78 0.00 39546.89 52 .5 3,203 . 11 0.00 156 G.C . BOND 15 ,500.00 14,854.00 0.00 0.00 ' ' 143854.00 95. 8 646.00 0.00 164ASBESTOS ABATEMENT 2,750.00 3 ,325 .00 0.00 0.00 3 ,325 .00 120.9 575 .00- 0.00 SITE WORK 168 SITE DELEVOPMENT 258,086.00 258,086.00 0.00 0.00 258,086.00 100.0 0.00 0.00 176 DEMOLITION 15 ,000.00 13 ,500.00 0.00 0.00 13 ,500.00 90.0 1 ,500. 00 0.00 180 GREASE TRAP/D.F. 3 ,000.00 39970. 50 0.00 0.00 3,970.50 132 .4 970. 50- 0.00 188 ERROSION CONTROL 1 ,500.00 1 ,693 .64 0.00 0.00 11693 .64 112.9 193 .64- 0.00 250 LANDSCAPING 55,000.00 47,220.00 18,530.75 0.00 65,750.75 119.5 10,750.75- 0.00 262 FENCING 9,855 .00 81422.00 0.00 0.00 89422 .00 85 .5 15433 .00 0.00 CONCRETE 274 CONCRETE SUB-CONTR 263, 100.00 266, 143 .50 11200.00 0.00 267,343 . 50 101.6 49243 . 50- 0.00 MASONRY 328 MASONRY SUB-CONTR. 6,000.00 31267 .45 0.00 0.00 35267.45 54.5 2,732 .55 0.00 356 MASONRY INSULATION 21500.00 2,377.00 0.00 0.00 2,377.00 95. 1 123 .00 0.00 METALS l 368 MISC. METALS 5,550.00 5,550.00 0 .00 0.00 5,550.00 100.0 0.00 0.00 733P841100 696,006.76 25,388 .08 0.00 721 ,394. 84 12,446. 16 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 G703TM - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 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, copyrightibaia.org. =-- AIA Document G703TM - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.ala.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703 , but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel , copyright@aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C : These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required . Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application.. including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period.) Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H : Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date) . Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A 9 C D E 1' C H I KORH (DMVLC I LU MATEM %TS TOTALL 84L>N PkE$F ViIV COUP( FTFD RC (AIA pGC ITEM SCAALLI FO PRFVTOI 4- 10 DF_SCRIYI IOV 01' WORk _ STORED AND STORED 111 RA 11 LG VO. VdLCE 4P LiCATIO� THIS PFFIOO YIVItiH NOT OR E) TO DI Ril Cl D - e, noR CI ,o-s.E, l 1 MOBILIZATION 5000 5000 .. 0 5000 100 0 2 STUMP REMOVAL 5,000 5000 0 0 5,000 130 0 3 EARTH WORK 15000 Iewo 5000 0 15000 100 0 4 LOWER RETAINING WALL iD 000 0 5000 0 5000 50 5,000 5 CURBS b MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000 R (AVERS 20000 0 0 10000 imox 53 10,000 9 BRICK WORK 50W 0 0 0 0 0 5,000 10 I n c5000 28000 1 10,000 10,000 1 40000 Il can AIA Document G703TM' - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978: 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAn 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. copyrightCaIaia.org. S T =AIA Document G703tN - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT 11 ,2007 In tabulations below, amounts are staled to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A B C D E F G H f WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED E TO RETAINAGE ITEM DESCRIP"fION OF WORK STORED AND STORED (IP VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G + C) FINISH RATE) (D + E) DOR E) (D+E+F) (C - G) 382 SHUTTERS/AWNINGS 6,307.00 6,306.59 0.00 0.00 6,306.59 100.0 0.41 0.00 394 PIPE BUMBERS 750.00 605 .48 0.00 0.00 605 .48 80.7 144.52 0.00 CARPENTRY 402 WOOD & LUMBER 28,500.00 27,846.97 19261 .55- 0.00 26,585 .42 93 .3 1 ,914.58 0.00 412 TRUSSES 25,000.00 25,433 .61 1 ,957 .61 - 0.00 23,476.00 93 .9 1 ,524.00 0.00 414 ROUGH CARPENTRY 64,600.00 65,357.00 0 .00 0.00 65,357.00 101 .2 757.00- 0.00 494 STAINLESS TOPS 6,500.00 6,325 .20 0.00 0.00 6,325 .20 97.3 174. 80 0.00 THERMAL/MOISTURE 502 CAULKING 4,000.00 54.00 0.00 0.00 54.00 1 .4 31946.00 0.00 504 INSULATION 5,850.00 5,824.00 0.00 0.00 5,824.00 99.6 26.00 0.00 514 ROOFING S.C . 27,800.00 32,600.00 0.00 0.00 327600.00 117.3 4,800.00- 0.00 524 GUTTERS/D. S. 0.00 23819.00 0.00 0.00 27819.00 0.0 2,819.00- 0.00 DOORS AND WINDOWS 550 H.M. DOOR - LABOR 51000.00 41000.00 0.00 0.00 43000.00 80.0 13000.00 0.00 552 H.M ./WOOD/HDW PKG 42,500.00 48,766.00 0.00 0.00 48,766.00 114.7 61266.00- 0.00 562 OVERHEAD DOORS 165500.00 15,730.40 0.00 0.00 15,730.40 95 .3 769.60 0.00 578 WINDOWS,GLASS & GLAZINC 11 ,275 .00 11 ,275 .00 0.00 0.00 115275 .00 100.0 0.00 0.00 FINISHES 604 STUCCO 365805 .00 41 ,892 .07 2,832 .93 0.00 44,725 .00 121 .5 7,920.00- 0.00 606 DRYWALL 61 ,000 .00 60,300.00 0.00 0.00 60,300.00 98.9 700.00 0.00 610 TILE/MARBLE 28,201 .00 28,201 .00 0.00 0.00 28,201 .00 100.0 0.00 0.00 622 ACOUSTIC CEILING 10,000.00 91370.00 0.00 0.00 97370.00 93 . 7 630.00 0.00 638 PAINTING 35,000.00 34,220.00 0.00 0.00 34,220.00 97. 8 780.00 0.00 415 ,588.00 426,926.32 386.23 - 0.00 426,540.09 10,952.09- 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 G7(l - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING : This AIA00Document 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 ter If 0) 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. = I Document G703TM Instructions A Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered In AIA Document A201 . General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia .org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C : These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required . Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application , including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F : Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column , Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period .) Column G : Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form . Construction Change Directives : Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of Continuation Sheet for work in progress, Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A P C D _ C (3 H 1 K KCORI DRPI FT' D A1TTFRIAl I(Y1AL 9 Al AVCE 9CFI6DUIliD FROy VRL'IOiS pRFSFN-fIV COl1YLLILD RF IAIFAGL IILM C DECRIIT0AOFAORK STORED ANO � I (1BGD JYIARIABLL VO. VALUF APPI I( AIION THIS PERIOD iG-L FVTO AH � naT In TO onrr. R.vr; m- Pi DORe) (D -F, K-ei 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5000 5000 0 5,000 100 0 3 EARTH WORK 15000 11 5,000 0 15000 100 0 4 LOWER RETAINING WALL 10 C00 C 5,000 0 5,000 50 5000 5 CURBS A MISc. cow 5000 0 0 0 0 0 5.000 6 PAVING, UPPER DRIVE 20000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 2exo 0 1 0 0 C 0 20,000 B PAVERS 20,ODo 0 0 10,000 10000 50 10000 9 BRICK WORK 5,000 1 0 0 0 0 0 5,000 10 11 105111 20000 10000 10000 40,000 65000 AIA Document G711992. Copyright © 1963, 1965, 1966. 1967.. 1970, 1978, 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 Architectslegal counsel, copyright@aia.org. - T = : I Document G703TN - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT It 52007 In tabulations below, amounts are stated to the nearest dollar. SEP 30,2007 Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: ARCHITECT'S PROJECT NO: 184 A B C D E F G H WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RFARIAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS % ICI (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD STORED AND STORED(NOT IN TO DATE (G . Q FINISH RATE) (D + E) D OR E) (D+E+F) (C - (i) SPECIALTIES 666 TOILET PARTITIONS 4, 155 .00 55585 .00 0.00 0.00 5,585.00 134.4 1 ,430.00- 0.00 673 FLAGPOLE 25010.00 19573 .25 0.00 0.00 15573 .25 78 .3 436.75 0.00 675 1DENT. DEVICES-MAT. 31,050.00 15570.97 0.00 0.00 1 ,570.97 51.5 11479.03 0.00 685 METAL SHELVING 1 ,000.00 426.72 0.00 0.00 426.72 42.7 573 .28 0.00 686 BATH ACC.-MAT:. 4,065 .00 31,502. 74 0.00 0.00 31502.74 86.2 562.26 0.00 689 CULTURED MARBLE 85100.00 71779.34 0.00 0.00 7,779.34 96.0 320.66 0.00 714 RESIDENTIAL ADPL. 15 ,900.00 15,553 . 59 294 .25 0.00 15 ,847.84 99.7 52. 16 0.00 723 GEAR HOSE & LOCKER ACCE S 11 ,498 .00 10,057. 88 0.00 0.00 10,057.88 87.5 1 ,440. 12 0.00 742 CASEWORK 34,264.00 34,264.38 0 .00 0.00 349264.38 100.0 0. 38- 0.00 MECHANICAL 785 PLUMBING 31 ,280.00 35,939.30 54.00 0.00 35,993 .30 115 . 1 4,713 .30- 0.00 788 SPRINKLER SYSTEM 55,000.00 54,800.00 0.00 0.00 54,800.00 99.6 200. 00 0.00 793 HVAC 104,457 .00 102,885 .00 0.00 0.00 102,885 .00 98 .5 1 ,572.00 0.00 800 KITCHEN HOOD 131,000.00 13,084.45 0.00 0.00 13,084 .45 100.6 84.45- 0.00 803 L/P TANK 81000.00 6,041 .07 496. 50 0.00 6,537.57 81 .7 1 ,462 .43 0.00 ELECTRICAL 811 ELECTRICAL S .C. 148,400.00 149,255 .25 301 . 53 0.00 149,556.78 100.8 11156.78- 0.00 827 GENERATORS 385500.00 385380.00 0.00 0.00 38,380.00 99.7 120.00 0.00 901 CONSTRUCTION FEE 190,069.00 190,069.00 0.00 0.00 1901,069.00 100.0 0.00 0.00 0001 CO # 1 173 ,665 .25- 165 ,240. 15- 81425 . 10- 0.00 173,665 .25 100.0 0.00 0.00 0002 CO #2 52,823 .90- 52,578. 34- 245 . 56- 0.00 52,823 .90 100.0 0.00 0.00 0003 CO #3 27, 198 .25- 245885 .98- 2,312 .27- 0.00 27, 198.25- 100.0 0.00 0.00 0004 CO 94 10,692 .27 0.00 1Q692 .27 0.00 10,692.27 100.0 0.00 0 .00 429,752 . 87 428,063 .47 855 .62 0.00 428,919.09 833 .78 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, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale 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. T I Document G703TM - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment., is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software, Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia .org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B & C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page . Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column . Column E : Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column . Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period. ) Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule . The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A 9 C F G H WORK C WiPLETED M TY.RIAIS IJ1I L B�ANCE PRPlF\TIY COl1YLLIEO REIAIFAGE ITEM SCRFOIII FD FROM PR F V IOLS 9 TO \O OLSCRIPn060FWORK V OF \PI'I I( \ 1106 IIHIS YLRIOD SNOT IN ANO DA I <1 -1 IC G , IF Vg21ABLE i o IN l01>A IL IUTE) 10- Ei !> OR EI N+li-FI IC G , 1 M061LIZATION 15,000 5,000 0 0 5000 100 0 2 STUMP REMOVAL 15,000 500C 0 0 5000 100 0 3 EARTH WORK 15,000 10,000 5.002 0 15,000 100 0 4 LOWER RETAININ6 WALL IOOoo 0 5,000 0 500 5o 5,000 5 CURBS d MItto cow 5000 o C 0 C 0 5,000 6 PAVING, UPPER DRIVE 20000 0 0 0 0 0 20000 7 PAVING, LOWER DRIVE 20,000 0 0 0 C 0 20,000 9 PAVERS 20000 0 C to Coo 10000 50 10,000 9 BRICK WORK 5,000 0 C 0 0 0 5,000 10 it 105000 20,000 10000 10,000 40,000 650G0 AIA Document G703TM — 1992. Copyright © 1963, 1965, 1966, 1967, 1970.. 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIAO 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, copyrightpa aia.org. _ =� = IA Document G703tN — 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 14 containing Contractor' s signed certification is attached. APPLICATION DATE: OCT 11 ,2007 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: SEP 30,2007 ARCHITECT'S PROJECT NO: 184 A R C U E F G H WORK COMPLETED MATERIALS TOTAL PRESENTLY COMPLETED BALANCE SCHEDULED FROM PREVIOUS % RETAINAGE ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED AND STORP.D (G = C) FINISH (IFVARIABLF. NO. (NOT IN TO DATE (C G) RATE) (U + E) D OR E) (D+E+F) 000.5 CO #5 57. 59- 0.00 57 .59- 0.00 57.59- 100.0 0.00 0.00 0006 CO #6 919762.38- 0.00 0.00 0.00 0.00 0.0 91 ,762.38- 0.00 108,702.90 1 ,773 ,564.91 35 , 137 .99 0.00 1 ,808,702 .90 100.0 0.00 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 G703Tu — 1992. CopyrightQ) 1963, 1965, 1966, 1967, 1970, 1978, 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. =AI Document G703TM1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702 , Application and Certificate for Payment, is to be used In conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 , General Conditions of the Contract for Construction . Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel , copyright@aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A. B & C : These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted . The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum . The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column . Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated In the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period . This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed—This Period.) Column G Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H : Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form . Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders, Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 . The following is an example of Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A a O WORK COMR£rED MATERIALS TOTAL 5iL AVCF IT EA1 SCHEDULED FROM Pli 1015 PRE6ENTIY COMPLETED q TO RFI4IAAGE NO DF_SCNILLION OFNF IAti ORK yALIAPPLICATION PERIOD STORED ANDlE + IFRED 'IFS ARIA3LL: (NOT IN 10DAIL f ( IC G]) BATF, `D + G IC DORE� iD+PwI^, - G 1 MOBILIZATION 5000 5000 0 0 5000 100 0 2 5TUMP REMOVAL 5,000 5000 0 0 5000 Ion 0 3 EARTH WORK 25,000 10000 5000 0 15,000 100 0 4 LOWER RETAINING WALL 10000 0 5000 0 5000 50 5,000 5 CWR56 MISC. CONC 5000 0 0 0 0 0 5000 6 PAVING. WPER CALVE 20000 0 0 0 0 0 20000 7 PAVING, LOWER DRIVE 20,000 0 0 0 v 0 20000 e FAVERS 20000 0 0 10000 10,000 50 10,000 9 BRICK WORK 5,00C 0 0 0 0 0 5,000 10 11 1 Oro 20000 10,030 10000 40000 65,000 AIA Document G703TM — 1992. Copyright © 1963, 1965. 1966, 1967, 1970, 1978, 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.