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HomeMy WebLinkAboutAPPLICATION - CERTIFICATE FOR PAYMENTAPPLICATION AND CERTIFICATE FOR PAYMENT OWNER: Hutchinson Island Beach Club Inc. 9800 S. Ocean Drive Jensen Beach, Fl 33957 FROM CONTRACTOR: Golden Construction Corp. 5977 Las Colinas Circle Lake Worth Fl. 33463 CONTRACTOR'S APPLICATION FOR PAYMENT L Application is made for payment, as show, in connection with the Contract. continuation Sheet is attached. 1.ORINIGALCONTRACT SUM'- -- 2.Net change by Change Orders 3. CONTRACT SUM TO DATE-- S. RETAINAGE: PAGE OF PAGES v+� PERIOD TO: 11/28/2018 x CONTRACTOR 3t{ PROJECT No: x OWNER I CONTRACT DATE: 6/26/2018 x ARCHITECT RECEIVED ENGINEER: SCANNED CE+ IVED CSM Engineering Inc DEC 19 018 208 SW Ocean Blvd. St. Lu e County DEC - 4 2018 Stuart Fl 34994 $ 293,013.00 $ 53,645.00 $ 346,658.00 A.5% of completed work I I (Columns D+E on"Continuation Sheet) B.10% of completed work (Columns D+E on Continuation Sheet) Total Retainage (line 5a+Sb or Total In Column 1 of Continuation sheet 6, TOTAL EARNED LESS RETAINAGE (Une 4 Less Une 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT— (Une6 from prior Certificated) B. CURRENT PAYMENT DUE: 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 Less Une 6) S 191,900.07 $ 117,294.17 $ .. 74,605.90' $ 154,757.93 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total Changes Approved in Previous months by Owner $ 52,645.00 Total Approved This Month $ 1,000.00 TOTALS $ 53,645.00 $ NET CHANGES by Change Order $ 53,645.00 The undersigned Contractor certifies that to the best of the contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed In accordance with the Contract Documents, that all amounths have been paid by the Contractor for Work for which previous Certificates for Payment were Issued and payments received from the Owner, and that current payment Shown there In Is now due. CONTRACTOR, State of / Florida County OfL West Palm Beach Subscribed and sworn to before me this , 28day of Notary Public �� My Commission Expires: CERTIFICATE FOR PAYMENT LUIS F. LIBREROS Notary Public - State of Florida Commission TO FF 189166 My Comm. Expires May 1, 2019 In accordance with Contract Documents, based on on -side observations and the data comprising appllation,the architect cenies to the Owner the o the best of the Architects knowledge, Information and belief the Work has progressed as Indiated,the quality of the Work Is In accordance with the Contract Documents, and the Contactor Is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED- ���ep©Sr�O (Attach explanatinifamount certified differs fromtheamo tappliedfor.initialallfiguresonthis application and on the ntlnuatl Sheetth arehanged to confo o the amount certified) ARCHITECT: ` I C Dated BY: This Certificate is of negotiable.the AMOUNT CERTIFIED Is payable only to #fe Contactor named herein.Issuance,payment and acceptance of payment are without pre)u to any rights of the Owner of Contractor under this Contract.