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HomeMy WebLinkAbout2009-337 ! � . A l . CHANGE ORDER Distribution to : AIA DOCUMENT G701 OWNER _ l ARCHITECT CONTRACTOR FIELD OTHER PROJECT : CHANGE ORDER NUMBER : 1 I . R . C . Fire Station # 12 3620 49`I' Street Vero Beach , FL 32960 INITIATION DATE : 11 /25 /09 TO : Barth Construction, Inc . CONTRACT DATE : 1717 Indian River Blvd . Suite 202A Vero Beach, FL 32960 You are directed to make the following changes in this Contract: Final Cost of Construction ( Including Contractor's Fee) $230159125 .23 Less Current Contract Amount $2 , 1571964 . 00 Change Order Amount <$ 1429838.77> 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 (Gentr-^ ^+ Sum ' (Guaranteed Maximum Cost) was . . . $ 2 , 157,964 . 00 . . . . . . . . . . . . . . . . . . . . . . . Net change by previously authorized Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 00 The (Guaranteed Maximum Cost) prior to this Change Order was . . . . . . . . . . . . $ 2 , 157 ,964 . 00 The (Contract Sum) (Guaranteed Maximum Cost) will be ( increased) (decreased) ( unchanged) bythis Change Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . 44 . 0 . . . . . . . . . - 142 838 . 77 The new (Contract Sum) (Guaranteed Maximum Cost) including this Change Order will be $ 290159125 . 23 The Contract Time will be ( increased) (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 Rivpr County Dept. of Emer. 65 Royal Palm Pointe , Suite D 1717 Indian River Blvd . 1840a25th Strt~eet Vero Beach , FL 32960 Suite 202A Vero `•Beach 610 Vero Beach , FL 32960 _ Q� O ' cyan BY : I BY : _ BY : Chairman DATE : DA E : �l'Z7r' S DATE : December 15 , 2009 AIA DOCUMENT G701 * CHANGE ORDER * APRIL 1978 EDITION * AIA * 1978 THE AMERICAN INSTITUTE OF ARCHITECTS , 1735 NEW YORK AVE . , N .W. , WASHINGTON, D.C. 20006 i + 1 i D O N A D I O & Associates , Architects , P.A . December 2 , 2009 Mr. John King Indian River County EMS 1840 25th Street Vero Beach, Florida 32960 RE : Indian River County Fire Station #12 Application for Payment #11 Project No. 5018.003 . 12 . 14 Dear Mr. King , We have reviewed the Application for Payment # 11 and to the best of our knowledge and belief, all work being requested for is in place . Please issue a check in the amount of $ 53 ,438 . 79 to Barth Construction for Application for Payment # 11 . Should you have any questions , please call . Sincerely , 12nthony J . Donadio A . I . A . , NCARB President AJD/bc cc : Barth Construction 609 17a' Street Vero Beach, Florida 32960 Phone 772 794 2929 Fax 772 562 8600 • Email daa@donadio-arch.com License No. AA0002238 G7AIA 04 2000 2000 Document G70 Certificate of Substantial Completion PROJECT: PROJECT NUMBER: / OWNER: ❑ (Name and address) : CONTRACT FOR: General Construction ARCHITECT: ❑ IRC Fire Station # 12 CONTRACT DATE: 9/ 16/08 3620 49" Street CONTRACTOR: ❑ Vero Beach, FL 32960 TO OWNER: TO CONTRACTOR: FIELD: ❑ (Name and address) : (Name and address) : OTHER: ❑ Indian River County Barth Construction, Inc. 1840 25th Street 1717 Indian River Blvd , Suite 202A 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 Dat ommencement Salue Edlund, Dritenbas, Binkley, / p Architects I � )670ar12 l6111 2oo 7 ARCHITECT BY DATE OF ISSUANCE A list of items to be completed or corrected is attached hereto. The failure to include any items on such list does not alter the responsibility of the Contractor to complete all Work in accordance with the Contract Documents. Unless otherwise agreed to in writing, the date of commencement of warranties for items 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 �jr �5'� ( �D��� • 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. Barth Construction, Inc. `pl/,?j�� � CONTRACTOR Y d DATT— The Owner accepts the Work or designated portion as substantially complete and will assume full possession at (time ) on (date). Indian River County OWNER BY DATE The responsibilities of the Owner and Contractor for security, maintenance, heat, utilities, damage to the Work and insurance shall be as follows : (Note: Owner 's and Contractor 's legal and insurance counsel should determine and review insurancerequirements and am:/9 / coverage.)/ill �pe"1,7o al ev sh , //71l/lt 7,wezF C��A� l 11 f ,11, G`5 o4 ll /, rs kco W,. '. 1h. O�v s .E �s�di/.,1� vs 40 �' r� oh AIA Document 13704' — 2000. Copyright ® 19630 1978, 1992 and 2000 by The American Institute of Architects. All rights reserved. WARNING . '11 is AIA Clorunleot is proterted by U . S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA' Uocerrnent, ur any portion of it, "lay result in severe civil .anti crirninal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 16: 10: 58 on 12/02/2009 under Order No. 1000396135_1 which expires on 04/2212010, and is not for resale. ( 1836272966) User Notes: low � TM 1994 Document G706 - Contractor's Affidavit of Payment of Debts and Claims PROJECT : (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: IRC Fire Station # 12 ARCHITECT: ❑ 3620 49" Street CONTRACT FOR: General Construction CONTRACTOR: ❑ Vero Beach , FL 32960 SURETY: ❑ TO OWNER: (Name and address) CONTRACT DATED: 9/ 16/08 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 G707, Consent of Vero Beach, FL 32960 Surety, may be used for this purpose Indicate Attachment ® Yes ❑ No BY : The following supporting documents should be attached (Si nature o authorized representative) hereto if required by the Owner.- 1 . Contractor ' s Release or Waiver of Liens, ( ranted name and tine ) 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. `�,, / ..JJ Notary Public /�� 1.J� 3, Contractor ' s Affidavit of Release of Liens My Commission Expires : 7' z i 112 (AIA Document G706A). MARION H. IUPEK k hill COMMISSION # DD 798038 ?; = EXPIRES: July 21 , 2012 Bonded Thni Notary Public Underwriters AIA Document G706TM — 1994. Copyright 0 1970 and 1994 by The American Institute of Architects. All rights reserved.. WARNING : This AIA` Document is protected by tl .S. Copyright Law slid international Treaties . Unauthorized reproduction or distribution of this AIA'' Document, or any Portion Of it. 1 is«ay rosrt9i ass seuern civil and crlrninal penalties, and will be prosecuted to the rnaxirnurn extent possible under the law. This document was produced by AIA software at 16: 11 :44 on 12/02/2009 under Order No. 1000396135_1 which expires on 04/22/2010 , and is not for resale. (793595443) User Notes: x �I . � } AIA Document G706Ar" - 1994 Contractor's Affidavit of Release of Liens PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER : El IRC Fire Station 412 ARCHITECT: ❑ 3620 49`" Street CONTRACT FOR: General Vero Beach, FL 32960 Construction CONTRACTOR: ❑ TO OWNER: (Name and address) CONTRACT DATED : 9/ 16/08 SURETY: ❑ Indian River County OTHER: ❑ 1840 25th Street 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 329 2. Separate Releases or Waivers of Liens from BY : /i; ;, tIIIIIIIIIIIII, Subcontractors and material and equipment (Signature of authorized suppliers, to the extent required by the Owner, r sentati e) accompanied by a list thereof fL gmyV 0 i fM6 r (Printed name and title) Subscribed and sworn to before me on this date: Notary Public: ✓ k�A� 1 My Commission Expires: .7 / Z Z, , " • MARION H. *' M' COMMISSI III DD 7 EXPIRES: J� 2 , 2 798038 8011101rnm IY Public 2012 � Notary Public UrxlBnters AIA Document G70BAT° — 1994. Copyright ® 1982 and 1994 by The American Institute of Architects. All rights reserved. WARNING : This AIA ' Document m prot((cted kly U ,S, Copyright Lav° and International Treaties . Unauthorized reproduction or distribution of this AIA Document, nr any portion of it, 1 r:ijy result in sevore civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law, This doeumentwas produced by AIA software at 16: 12: 19 on 12/02/2009 under Order No. 1000396135_1 which expires on 04/22/2010, and is not for resale. ( 1213547073) User Notes: 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 Department of Emergency (name, address) Services Fire Station # 12, 3620 49th St. . Vero Beach , FL 32960 TO (Owner): Indian River County ARCHITECT'S PROJECT NO: 4225 43rd Avenue CONTRACT FOR: General Construction Vero Beach, FL 32960 BOND NO: 54- 175858 CONTRACT DATE : Sept. 16th , 2008 CONTRACTOR: Barth Construction, Inc . 1717 Indian River Blvd , Suite # 202A Vero Beach , FL 32960 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 , SURETY COMPANY, on bond of (here insert name and address of Contractor) Barth Construction , Inc. 1717 Indian River Blvd , Suite # 202A Vero Beach , FL 32960 , 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 Owner) Indian River County 4225 43rd Avenue Vero Beach , FL 32960 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this day of December 3 , 2009 United Fire & Casualty Company Surety Company �,, / By • X"; >d Signature of Authorized Representative Attest: (Seal): Leslie M . Donahue Title Attorney- in- Factand FL Licensed Resident Agent Inquiries • (407 ) 786-7770 NOTE: This form is to be used as a companion document to AIA DOCUMENT 0706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA® ONE PAGE 0 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave. , NW, WASHINGTON, D.C. 20006 UNITED FIRE & C/ASUALTY. COMPANY HOME, :f3FFICE • CEDAR RAPIDS , IOWA CERTIFIED: COPY OF POWER OF A'1TTORNEY ( Original on file at Home Office of Company - See Certification ) #CNOW ALL 'MEN BY THESE 'PRESENTS , That the UNITED FIRE & CASUALTY COMPANY a corporation . duly organized and existing under the laws of the ;State of: Eowa , end having its principal office it Cedartapids; State of lowa , : does make, constitute and app99 olnt LESLIE M DONAHUE , OR KIM E 'NIV , OR JEFFREY .1k :; REICH OR SUSAN ,L REICH , OR TERESA L DURHAM , OR PATRICIA L SLAUGHTER , OR J GREGOR MACKENZIE , . OR GLORIA A RICHARDS $ OR DON BRAMLAGE , OR LISA ROSELAND ALL INDIVIDUALLY of MAITLAND FDL 9 9 its true< and . lawfu ( Attorney( s')-in-Fact with power and authority hereby Conferred to sign , seal and execute i`n its behalf all lawful bonds, undeltakings anti other obligatory Instrument s' of similar nature as follows: ,Any and A11 . Bonds . and to bind Uh11TED FIRE & :CASUALTY COMPANY thereby as. fully in: to: the same extent as if such instruments were signed by ; the duly authorized of€icers of UNITED FIRE & CASUALTY COMPANI . Y' 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 #ollovving BywLaw duly adopted`'by , Board of Directors of the Company on April '18 ; 1973 . Article V Surely Roads and Undertakings"; Section 2, Appointmint of Attorney=in-Fact. The President or any Vice President; or any other officer af; 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 attorneys-in, fact, subject to thelimitations set forth in their respective certifidates 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. ��r ►►upur� IN WITNESS WHEREOF, the UNITED FIRE & CASUALTY COMPANY has caused these presents to be signed by !�.,f��* its vies president and its corporate seal to be hereto affixed this 27th day of January , 2009 se' s � =RA UNITED FIRE & CASUALTY COMPANY Slott By State of Iowa„County :of Linn;' ss: Vice President On 27th day of January , = 2009 before me personalty came Dennis J . Richmann to me known, , whn being by irte duly sworn , did depose and say; that he resides in Cedar Rapids, State of lawa; that he is a Vice President of ted the UNITED FIRE & CASUALTY COMPANY , the corporation described in and which executhe above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporateseal ; 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. 61 :- Mary A. 46nsen ' - Iowa Notarial Seal * • Cammiasfon number 713273 ` MyComm➢asionExpi[as Notary PUbIIC 10@8710 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 by-laws of said Company ;as set forth in ad Power, of Attorney, with the ORIGINALS; ON , JN THE #TOME UFFI CE OF SAID COMPANY; and . that the same are correct transcripts thereof, and` of thewhole of the said originals, and:'that the sa{d flower ofAttorney has not been revoked and is now in full force and effect#. �,�d�t�3,kHlj� In testimony whereof I have hereunto subscribed: my name and' affixed the corporate seal of the said :company �. % this 3rd day of 20 pg � . i VNtm RATE ' R '. Si3AL ;� a+►„►„ +� Secretary BPOA00190706 as AIA Document G702TM - 1992 � -- Application and Certificate for Payment TO OWNER: PROJECT : APPLICATION N0: I I Distribution to :: INDIAN RIVER COUNTY 204 IRCFD # 12 - PART 2 PERIOD T0 : 11 /25/09 OWNER �" 4225 43RD AVENUE 3620 49TH STREET 111 VERO BEACH, FL 32960 VERO BEACH, FL 32960 CONTRACT FOR: 204 ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE : 09/ 16/08 CONTRACTOR ❑ BARTH CONSTRUCTION, INC . EDLUND & DRITENBAS ARCH. P.A . 1717 INDIAN RIVER BLVD. , SUITE 202A 65 ROYAL PALM BLVD. , S . D PROJECT NOS : / / FIELD ❑ VERO BEACH, FL 32960 VERO BEACH, FL 32960 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 which previous Certificates for Payment were issued and payments received from the Owner, and 1 , ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 211579964 ,00 that current payment shown herein is now due. 2 . Net change by Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ - 142,838 .77 CONTRA C OR: 3. CONTRACT SUM TO DATE (Line 1 ± 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,0159125 .23 By: N Date : 4, TOTAL COMPLETED & STORED TO DATE (Column G on G703 ) . . . . . . $ 2,0151125 .23 State Lv S. RETAINAGE : Con of: IAID,IHV 4Cl VC)CL a, % of Completed Work Subscribed and sworn to before , ,,, , MMM (Column D + E on G703 ) $ me this Z� K day of AfbV �f� � � � � 0 j W AIMIMION # DD 790038 b. % of Stored Material 5kwry . � IXPIRES: July 21 , 2012 (Column F on G703) $ Notary Public : BontlWThruWtoryPublic lJndennttors My Commission expires : Total Retainage (Lines 5a + 5b or Total in Column I of G703) . . . . . . . $ 0 ,00 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,0151125 .23 ARCHITECT' S CERTIFICATE FOR PAYMENT (Line 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 . . . . . . . . . . . . . . . . . . . . . . $ 19961 ,686 .44 this application, the Architect certifies to the Owner that to the best of the Architect' s knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 535438 . 79 AMOUNT CERTIFIED. Q �J 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ C� (Line 3 less Line 6) $ 0 ,00 (Attach expla on if amount certifie iffers from the amount applied. Initial all figures on this Applicatio and n the Continu t ' eet that are changed to conform with the amount certified. ) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHIT T: Total changes approved in previous months by Owner $ 0 .00 $ 0 . 00 By : Date : ZAC Total approved this Month $ 0 .00 $ 142, 838 . 77 This Certificate is not negotiable . The AMOUNT CERTIFIED is payable only to the Cont or TOTALS $ 0 ,00 $ 142 , 838 . 77 named herein . Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ - 142 , 838 . 77 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 G702TM — 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 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. lisl Document G702 — 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 (EULA) . 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 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 ( 1 o) 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 . ss AIA Document G703TM - 1992 Continuation Sheet AIA Document G702Tm. Application and Certification for Payment, APPLICATION NO: 11 containing Contractor' s signed certification is attached. APPLICATION DATE: NOV 27,2009 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: 25 ,2009 204 ARCHITECT'S PROJECT N0 : 204 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS BALANCE SCHEDULED FROM PREVIOUSPRESENTLY COMPLETED % ITEM DESCRIPTION OF WORK FINISH RETAINAGE VALUE APPLICATION THIS PERIOD STORED AND STORED (G - C) FSH (If variable rate) NO. TO DATE (D + E) (Not in (D + E + F) (C - G) GENERAL CONDITIONS 25 PROJECT ACCOUNTING 10,320 .00 39291 .69 478 . 80 0.00 39770 .49 36. 5 65549 . 51 0 .00 27 PROJECT ADMIN , 7,740 .00 2, 865 .92 629.44 0.00 3 ,495 . 36 45 .2 41244.64 0.00 28 FIELD SUPERVISION 1299000 .00 1019336.08 119482 .28 0.00 112, 818 . 36 87 . 5 165181 .64 0.00 29 PROJECT MANAGEMENT 865000 .00 37,912 .04 81891 . 10 0.00 469803 . 14 54.4 39, 196. 86 0.00 36 TRAILER RENTAL 2,800.00 1 ,973 .00 0 .00 0 .00 1 ,973 .00 ` 70.5 827 .00 0.00 38 TEMP. WATER 750.00 282 .67 51 .34 0 .00 334 .01 44.5 415 .99 0.00 40 TEMP. POWER 750.00 11323 .96 0.00 0.00 19323 .96 176 .5 573 .96- 0. 00 42 TELEPHONE 19500.00 0.00 0 .00 0.00 0.00 0.0 1 ,500.00 0 .00 44 'TEMPORARY TOILET 11000.00 706. 71 0 .00 0 .00 706. 71 70 .7 293 .29 0.00 50 PROJECT SIGN 500.00 615 .25 0 .00 0 .00 615 .25 123 . 1 115 .25- 0.00 52 TEMPORARY FENCE 21200.00 6,638 .28 0 . 00 0 .00 69638 .28 301 .7 41438 .28- 0 .00 54 FIELD OFFICE SUPPLIES 50.00 0.00 0 . 00 0.00 0 .00 0 .0 50 .00 0 .00 58 TEMP, PROTECTION 19000 .00 686. 74 0 .00 0.00 686 . 74 68 .7 313 .26 0.00 68 FIRST AID 50. 00 0.00 0 .00 0.00 0 .00 0 . 0 50 .00 0.00 70 SAFETY 250.00 0 .00 0. 00 0 .00 0 .00 0. 0 250 .00 0.00 71 PRINTING/POSTAGE 21500 .00 19666. 09 0 . 00 0 .00 1 ,666 .09 66 . 6 833 .91 0 .00 74 PHOTOGRAPHY 50 .00 0.00 0 . 00 0 . 00 0 . 00 0 .0 50 .00 0.00 77 ARCHITECTURAL FEES 499190 . 00 48 , 795 .44 395 .41 0 .00 49, 190 . 85 100 .0 0 . 85 - 0.00 78 ENGINEERING 85500.00 89500 . 00 69650 .00 0 .00 155150 .00 178.2 69650 .00- 0 .00 80 SOIL TESTING 35500 .00 29402 .50 0 .00 0.00 2,402 . 50 68 .6 1 ,097 . 50 0 .00 82 CONCRETE TESTING 19500 . 00 21150.00 0 . 00 0 .00 2, 150.00 143 .3 650 . 00- 0 . 00 88 SM . TOOL/SUPPLIES 3 ,000 .00 19623 . 77 11320 .21 0 .00 2,943 .98 98 . 1 56 . 02 0 . 00 92 HOUSEKEEPING LABOR 31000 .00 39376 . 33 0 .00 0 . 00 31376 . 33 112 . 5 376 . 33 - 0 . 00 GRAND TOTAL 3151150. 00 226, 146 .47 29, 898 . 58 0 .00 2569045 .05 1 1 599104 .95 0 .00 CAUTION : You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured . AIA Document G703T - 1992. Copyright © 1963 , 1965 , 1966 , 1967, 1970, 1978t 1983 and 1992 by The American Institute of Architects. All rights reserved . WARNING : This AIA® Document is protected by U .S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed . To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel , copyright@aia .org . Tot. Document G703TM ons 1992 Instructi Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702TM, 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 A201Tm, 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 G703-1992 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 B C D E F O rFINISH MATERIALS TOTAL PRESENTLY COMPLETED % RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS AND STORED NO VALUE APPLICATION THIS PERIOD STORED TO DATE (G + C) (If variable ra/e) (D + E) (NotbiDwi) (D + E + f)1 MOBILIZATION 5,000 5,000 0 0 5,000 100 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 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 B PAVERS 20,000 0 0 10,000 10,000 50 10.000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 30 65,000 t1 GRAND TOTAL 105,000 20,000 10,000 10000 40,000 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 A10 Document is protected by U .S. Copyright Law and International Treaties, Unauthorized reproduction or distribution of this A10Documentsor any portion of it, may result in severe civil and criminal penalties, and will be hf o oecuted to the maximum lations of AIA Contract extent possible a e-mail Ther Ameriw.can Institute Purchasers e s are per tted to reproduce ten ( I o) copies of this document when completed . To report copyright counsel , copyright@aia.org . � ® TM ODocument G703 - 1992 Continuation Sheet AIA Document G702TM, Application and Certification for Payment, APPLICATION NO: 11 containing Contractor' s signed certification is attached. APPLICATION DATE : NOV 27,2009 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO : NOV 25 ,2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0 : 204 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY % TO RETAINAGE VALUE APPLICATION THIS PERIOD STORED AND STORED (G - C) FINISH (If variable rate) NO. (D + E) (Not in D or E) TO DATE (C - G) (D + E + F) 94 FINAL CLEANING 21200.00 11922 .67 175 .00 0 .00 2,097 .67 95 . 3 102 .33 0.00 118 SURVEYING 18,000 .00 169762 .51 853 . 76 0 .00 17,616.27 97 . 9 383 . 73 0.00 124 COMMON LABOR 31000 .00 3 , 860 .73 289 .20 0.00 49149.93 138 .3 1 , 149.93 - 0 .00 126 DUMP CHARGES 109000 .00 67594 . 15 309 . 51 0.00 63903 .66 69 .0 37096. 34 0.00 144 BUILDERS RISK 8,550.00 89059. 53 0.00 0.00 89059 .53 94 . 3 490.47 0.00 148 LIABILITY INSURANCE5 ,700.00 5 ,700 .00 0.00 0 .00 51700 .00 100 .0 0 .00 0.00 150 CONTINGENCY 409000 .00 229131 . 13 91561 .22 0 .00 315692 :35 79.2 89307.65 0.00 152 BUILDING PERMIT 79500 .00 129493 .26 0 . 00 0 .00 121493 .26 166 .6 49993 .26- 0 .00 156 G.C. BOND 15 ,300.00 15 ,385 .33 0 .00 0.00 159385 .33 100.6 85 .33- 0.00 SITE WORK 168 SITE DELEVOPMENT 218,000 .00 198,777 .00 5 , 198 .00 0.00 2037975 .00 93 .6 14,025 .00 0.00 180 GREASE TRAP/D.F . 41500 .00 21900.00 0 . 00 0.00 2 ,900 .00 64.4 19600 .00 0 .00 247 TEMP IRRIGATION 55500.00 0 .00 0.00 0 .00 0 .00 0 .0 59500.00 0.00 250 LANDSCAPING 799707 .00 1149161 .37 261 .00 0.00 114,422 .37 143 .6 34,715 .37- 0.00 252 RELOCATE TREES 8 ,664 .00 0.00 0 . 00 0.00 0.00 0 .0 81664 .00 0.00 254 SEEDING & SOD 26,224 .00 109263 . 15 0 .00 0 .00 107263 . 15 39. 1 15 ,960 . 85 0 .00 262 FENCING 6,898 .00 61168 .00 0 .00 0 .00 6, 168 . 00 89 .4 730 . 00 0 .00 264 SOIL POSION 21000 . 00 0.00 0 .00 0 .00 0.00 0 .0 2,000 . 00 0 . 00 CONCRETE 274 CONCRETE SUB-CONTR 226,500 .00 228 ,086.00 0 . 00 0 . 00 2289086 . 00 100.7 1 ,586.00- 0 .00 318 GYPCRETE/TOPPINGS 11500 .00 19280 .00 0 .00 0 .00 15280 .00 85 . 3 220 .00 0 .00 MASONRY 350 GLASS MASONRY 41500 .00 39334 . 50 0 .00 0 .00 3 ,334 . 50 74 . 1 1 , 165 . 50 0 .00 I I I I - -7 T GRAND TOTAL 694,243 . 00 6571879 . 33 167647 .69 0.00 674, 527 . 02 19, 715 . 98 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 , 19657 19669 1967, 1970, 19789 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 . +es TM = = Document G703 - 1992 Instructions _ Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702TM, 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 A201TM, 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 G703-1992 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 1. 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 B C D E F GWORK CC MPLFTFQ H I MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PREVIOUS COMPLETED DESCRIPTION OF WORK PRESENTLY Y. NI RETAMAGE NO. VALUE APPLICATION THIS PERIOD STORED AND STORED (G + 0 FINISH (If variable rale) (D + E) (NdurDc.E1 TO DATE (C - G) (D + E + F) I MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 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 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 U GRANDTOTAL 105,000 20,000 10,000 10,000 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. 1A Document G703TM - 1992 • Continuation Sheet AIA Document G702TM, Application and Certification for Payment, APPLICATION NO: 11 containing Contractor' s signed certification is attached'. APPLICATION DATE : NOV 2772009 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 : 25 ,2009 204 ARCHITECT'S PROJECT NO: 204 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY % TO RETAINAGE AND STORED VALUE APPLICATION THIS PERIOD STORED (G + C) FINISH (If variable rate) NO. (D + E) (Not inDorE) TO ODATF) (C - G) METALS 368 MISC . METALS 8,500.00 3 ,257.00 0.00 0.00 39257 .00 38 . 3 59243 .00 0.00 382 SHUTTERS/AWNINGS 59550.00 4,747 .77 0 .00 0.00 49747 .77 85 . 5 802 .23 0.00 394 PIPE BUMBERS 875 .00 619.64 0.00 0.00 619 .64 70. 8 255 . 36 0. 00 CARPENTRY 402 WOOD & LUMBER 33 ,000.00 1 %503 .26 929 . 94 0 .00 20,433 .20 61 .9 129566. 80 0 .00 412 TRUSSES 199950.00 19,920.76 0 .00 0 .00 19,920 . 76 99 . 9 29 .24 0.00 414 ROUGH CARPENTRY 64,420.00 669298 .00 0 .00 0.00 667298 .00 102 .9 11878 .00- 0.00 494 STAINLESS TOPS 89800.00 8,424 .00 0 .00 0.00 81424.00 95 . 7 376 .00 0.00 THERMAL/MOISTURE 502 'CAULKING 25100.00 0 .00 0. 00 0.00 0.00 0.0 29100.00 0. 00 504 INSULATION 3 ,900.00 3 ,823 .00 0 .00 0.00 3 , 823 .00 98 .0 77 .00 0 . 00 506 FOAM INSULATION 37500 .00 29377 .00 0 .00 0 .00 29377.00 67 .9 15123 .00 0 .00 514 ROOFING S .C . 37,500 .00 37 ,500. 00 0.00 0 .00 379500.00 100.0 0.00 0 .00 524 GUTTERS/D . S . 25379.00 2 ,379 .00 0.00 0 .00 21379.00 100 .0 0.00 0 .00 DOORS AND WINDOWS 546 H.M. DOORS/FRAMES 64, 155 .00 649155 .00 295 .00 0 . 00 649450 .00 100 . 5 295 .00- 0.00 550 H,M. DOOR - LABOR 5 ,500 . 00 4,750 . 00 0 . 00 0 . 00 4 , 750 .00 86 .4 750 . 00 0.00 562 OVERHEAD DOORS 19, 500 .00 199770 . 02 0 . 00 0 .00 199770 .02 101 .4 270 .02- 0.00 578 WINDOWS,GLASS & GLAZING 99952 .00 10,281 . 84 0 .00 0.00 10,281 . 84 103 .3 329 . 84- 0.00 FINISHES 604 STUCCO 35 ,597 . 00 25 , 765 . 00 0 .00 0 .00 259765 .00 72 .4 95832 .00 0.00 606 DRYWALL 589900.00 54,400 .00 0 .00 0 .00 54,400. 00 92 .4 49500 . 00 0.00 610 TILE/MARBLE 43 ,000 .00 40,250 .00 0 . 00 0 . 00 409250 .00 93 .6 29750 . 00 0 .00 GRAND TOTAL 4279078 .00 3885221 .29 19224.94 0 . 00 389,446.23 379631 . 77 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, 19789 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 . Document G703TM 1992 Instructions _ Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702TM, 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 A201TM, 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 13703-1992 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 B C D E F G H I MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PREVIOUS COMPLETED DESCRIPTION OF WORK PRESENTLY % TO RETAINAGE VALUE APPLICATION THIS PERIOD STORED AND STORED (C + C/ FINISH (If variable rate) NO. D DATE (D + E) (Nd inDoE) (p + E + F) (C - C) 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 MI5c. 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 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 f0 11 GRAND TOTAL 105,000 20,000 10,000 10,000 40,000 65.000 AIA Document G7031 - 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 . 1A = � Document G703TM - 1992 Continuation Sheet AIA Document G702TM, Application and Certification for Payment, APPLICATION NO: 11 containing Contractor' s signed ,certification is attached. APPLICATION DATE : NOV 2792009 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0 : 25 ,2009 204 ARCHITECT'S PROJECT N0 : 204 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY % TO RETAINAGE VALUE APPLICATION THIS PERIOD STORED AND STORED (G . C) FINISH (if variable rate) NO. + E) (Not in Dor E) TO DATE (D + E + F) (C - G) 618 MARBLE SILLS 366 .00 0.00 0.00 0.00 0 .00 0 .0 366 .00 0.00 622 ACOUSTIC CEILING 89562 .00 8 ,562 .00 0. 00 0.00 8,562.00 100.0 0.00 0.00 638 PAINTING 36,500 .00 28,700.00 0.00 0.00 28,700.00 78 .6 7, 800.00 0 .00 SPECIALTIES 666 TOILET PARTITIONS 69750 .00 6,720.00 0.00 0.00 69720.00 99.6 30.00 0 .00 667 LOUVERS 1 ,500.00 0.00 0.00 0.00 0.00 0 .0 19500 . 00 0.00 669 WALL COR. GUARD ° 19305 .00 955 .00 0.00 0.00 955 .00 73 .2 350 . 00 0.00 671 FIRE EXTINGUISHER/EQUIP 1 , 100.00 0.00 0.00 0 .00 0 .00 0 .0 1 , 100.00 0.00 673 FLAGPOLE 29500.00 11545 .00 0 .00 0. 00 11545 .00 61 . 8 955 .00 0 .00 675 IDENT.DEVICES-MAT. 39200.00 0 . 00 677 . 76 0.00 677 . 76 21 .2 29522 .24 0 .00 685 METAL SHELVING 19000.00 0 .00 441 . 37 0 .00 441 . 37 44. 1 558 .63 0 .00 686 BATH ACC .-MAT. 19525 .00 19638 .73 0 .00 0 .00 11638 . 73 107. 5 113 . 73 - 0.00 688 BATH ACC . -LAB , 500.00 11000 .00 0 .00 0 .00 11000 .00 200.0 500.00- 0 .00 689 CULTURED MARBLE 99068 .00 91067 . 85 0 .00 0. 00 95067 . 85 100.0 0. 15 0.00 EQUIPMENT 714 RESIDENTIAL APPL . 159650 .00 179007 . 10 0.00 0.00 17,007 . 10 108 . 7 19357 . 10- 0.00 723 GEAR HOSE & LOCKER ACCESS 123314 . 00 11 ,709 .00 0 .00 0.00 11 ,709 .00 95 . 1 605 . 00 0.00 FURNISHINGS 742 CASEWORK 389800.00 38,802 .02 0 .00 0 .00 38, 802 . 02 100.0 2 . 02- 0.00 MECHANICAL 785 PLUMBING 43 , 800 .00 43 , 800 .00 0.00 0 .00 435800 . 00 100 .0 0 .00 0.00 788 SPRINKLER SYSTEM 55 , 895 .00 50,675 .00 0 . 00 0 .00 50,675 .00 90. 7 59220 . 00 0.00 793 HVAC 83 ,336 . 00 83 ,421 .00 0 . 00 0 .00 83 ,421 .00 100. 1 85 . 00- 0.00 800 KITCHEN HOOD 14,800 . 00 149800 .00 0 .00 0.00 149800.00 100 .0 0 . 00 0 .00 GRAND TOTAL 338,471 . 00 318 ,402 . 70 1 , 119 . 13 0.00 319, 521 . 83 18 ,949 . 17 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, 19702 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 Ale 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 . v TM - 1992 Instructions i Document G703 Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702TM, 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 A201TM, 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 G703-1992 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 B C D E F G HWORK CC VIP[ FTED I MATERIALS TOTAL BALANCE COMPLETED ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED NI RETAINAGE NO. DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED AND STORED /G + C) FINISH (If variable rale) (D + E) (NdhDo E) D DATE (C - G) (D + E + F) I MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 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 B PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 GRAND TOTAL 305,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703T11 - 1992. Copyright m 1963, 1965, 1966, 19679 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 . oA 1A Document G703` - 1992 Continuation Sheet AIA Document G702TM, Application and Certification for Payment, APPLICATION NO: 11 containing Contractor' s signedcertification is attached. APPLICATION DATE : NOV 27 ,2009 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO : NOV 2592009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0 : 204 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE SCHEDULED FROM PREVIOUS PRESENTLY AND STORED % TO RETAINAGE ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED (G _ C) FINISH (If variable rate) f NO. (D + E) (Not inDorE) (D+DATE) (C - G) 803 L/P TANK 9,071 .00 85220 . 86 265 .28 0.00 8,486 . 14 93 .6 584 . 86 0 .00 ELECTRICAL 811 ELECTRICAL S .C. 1769800.00 1719664 .79 381 .32 0 .00 172,046 . 11 97.3 4,753 . 89 0 .00 820 DATA/COMM SYSTEMS 69000.00 0.00 39901 . 85 0.00 39901 . 85 65 ,0 2,098 . 15 0.00 901 CONSTRUCTION FEE 1919151 .00 1919151 .00 0.00 0 .00 1919151 .00 100.0 0.00 0 .00 0001 CO # 1 1429838 .77- 0.00 0 .00 0 .00 0 .00 0 .0 142,838 .77- 0 .00 GRAND TOTAL 23015 , 125 .23 1796 1 fi86 .44 53 ,438 .79 0 .00 290159125 .23 100 .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 G703 TM - 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 . t� TM_ AIADocAll ument G7031992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702TM, 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 A201TM, 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 G703A992 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 B C D E G H F 1 MATERIALS TOTAL BALANCE PRESENTLY COMPLETED y, TO RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS AND STORED NO. VALUE APPLICATION THIS PERIOD STOREDJ TO DATE (G + C1 FINISH (Ijwriable rate) (D + E) (D + E + F) 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5.000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5.000 5 CURBS 6 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 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 GRAND TOTAL 105,000 20,000 10,00010,000 40,000 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 ies, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to portion of It, may result in severe civil and criminal penaltreport copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal reproduce ten ( 10) copies of this document when completed . l counsel , copyright@aia.org.