HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENTG702 APPLICATION and CERTIFICATE for PAYMENT Me 3-00;5 2a
To: Atlantis "B"
10152 S Ocean Drive
Jensen Beach, Florida
From: Blue coast Construction
2587 SE Monroe st
Stuart, Florida 34997
Project: Atlantis B
Stack No. 20 Balconies
replacement
SCANNED
BY
St. Lucie County
Contract For: Concrete Restoration Engineer: Mathers Engineering
APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract.
Continuation Sheet, G703, is attached.
1. ORIGINAL CONTRACT SUM
o.00
2. Net Change By Change Orders
226,623.82
3. CONTRACT SUM TO DATE
226,sz3.82
4. TOTAL COMPLETED AND STORED TO DATE
226,623.82
5. RETAINAGE:
a. of Completed Work
b. of Stored Material
TOTAL RETAINAGE
6. TOTAL EARNED LESS RETAINAGE
0.00
0.00
0.00
226,623.82
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 204,960.81
8. CURRENT PAYMENT DUE 21,663.01
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
226,623.82
0.00
Total approval this Month
0.00
0.00
TOTALS
226.623.82
0.00
NET CHANGES b Change Order
226.623.82
Application No: 6
App. Date: December 23, 2015
Period to:
Project No:
Contract Date:
Distribution to:
❑ OWNER
❑ CONSTRUCTION MGR.
❑ ARCHITECT
❑ CONTRACTOR
® ENGINEER
The undersigned Contractor certifies that to the best of the Contractors knowledge,
information and belief the Work covered by this Application for Payment has been completed
in accordance with the Contract Documents, that all amounts have been paid by the
Contractor far Work forwhich previous Certificate f'fr 11 m n weri'issu d`end a ments
received from the Owner, andthatcurrent payme���F�9W r� r tfow rev
CONTRACTOR: III III FEB 3 REC'D
By: Date:
State of: L County of:
Subscribed and sworn before me this day of
The above personally appeared before me, the undersigned notary public, and provided
satisfactory evidence of identification to be the person who signed this document in my
presence and swore or affirmed to me that the contents of this document are truthful and
accurate to the best of his/her knowledge and belief.
Notary Public: My Commission expires:
ENGINEER'S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data
comprising this application, the Engineer certifies to the Owner that to the best of the
`
Engineers knowledge, 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 AMOUNT CERTIFIED.
AMOUNT CERTIFIED
(Attach explanation if amount certified differs from the amount applied for. Initial all figures
on this Application and on the Continuation Sheet that are changed to conform to the
amount certified.)
ENGINEER
[+'
By: Date:
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
CAUTION: You should use an original document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced.
TORGO SOFTWARE wmx.T.rg.S.ft a,..=m 01996-2013 ALL RIGHTS RESERVED
CONTINUATION SHEET G703 PROJECT: Atlantis B
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing
Contractor's signed Certification is attached.
Use Column I on Contracts where variable retainage for line items may apply.
Blue coast Construction Page 1 of 2
Application No: 6
App. Date: December 23, 2015
Period to:
Project No:
A
B
C
D
E
F
G
H
I
Item
#
Description of Work
Schedule
of
Values
Work Com
leted
Materials
Stored & Used
Prior+Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Period
1
Permit
2,493.72
2,493.72
-2.493.72
2
Mobilization
7,500.00
1
7,500.00
1 -7,500.00
3
Full Depth Repair
0.00
3.841.50
0.001
3,841.50
?
-3.841.50
0.00
4
#5 Dowels
0.00
5,950.00
0.00
5,950.00
?
-5,950.00
0.00
5
Beam Spells (Lx6"x6")
0.00
0.00
0.00
0.00
?
0.00
0.00
6
Column Spells (Lx6"x6")
0.00
270.00
0.00
270.00
?
-270.00
0.00
7
Stucco repairs
0.00
912.16
0.00
912.16
?
-912.16
0.00
8
Shutters Removal
0.00
5,832.00
0.00
5,832.00
?
-5,832.00
0.00
9
Door Frame removal and re -installation
0.00
3,842.50
0.00
3,842.50
?
-3,842.50
0.00
10
IDoor Framing bottom track replacement
0.00
0.00
0.00
0.00
?
0.00
0.00
11
ITile Removal
0.00
117.54
0.00
117.54
?
-117.54
0.00
12
Rust Spots
0.00
0.00
0.00
0.00
?
0.00
0.00
13
Wall Cracks
0.00
0.00
0.00
0.00
?
0.00
0.00
14
Interior Dust Wall Installation and Removal
0.00
2,275.60
0.00
2.275.60
?
-2,275.60
0.00
15
Gardrail Removal
0.00
3,240.00
0.00
3,240.00
?
-3,240.00
0.00
16
guardrail Replacement
0.00
19,558.80
0.001
19,558.80
?
-19,558.80
0.00
17
Concrete Beam Repair
0.00
5,639.40
0.00
5,639.40
?
-5,639.40
0.00
18
lConcrete Column Repair
0.00
5,166.60
0.00
5,166.60
?
-5,166.60
0.00
19
Grinding Decks
0.00
2,565.00
0.00
2,565.00
?
-2,565.00
0.00
20
IDrip Edge Installation
0.001
486.00
0.00
486.00
?
-486.001
0.00
21
Concrete Deck Replacement
0.00
141,000.00
0.00
141,000.00
?
-141,000.00
0.00
13
PAGE 1 TOTAL: 1 0.001 210,690.821 0.001 1 210,690.82 ?-210,690.82 0.00
A Line Item Number B=Brief Item Description C=Total Value of Item D=Total of D and E From Previous Application(s) (If Any) E=Total Work Completed For This Application
F=Materials Purchased and Stored for Project G=Total of All Work Completed and Materials Stored for Project H=Remaining Balance of Amount to Finish 1=Amount Withheld from G
TORGO SOFTWARE u .TorgoSoftware.wm®1996-2m3 ALL RIGHTS RESERVED
CONTINUATION SHEET G703 PROJECT: Atlantis Blue coast Construction Page 2of2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing
Contractor's signed Certification is attached.
Use Column I on Contracts where variable retainage for line items may apply.
Application No: 6
App. Date: December 23, 2015
Period to:
Project No:
A
B
C
D
E
F
G
H
I
Item
#
Description of Work
Schedule
of
Values
Work Com leted
Materials
Stored & Used
Prior + Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Period
22
Cathodic
0.00
650.00
0.00
650.00
?
-650.00
0.00
23
Edge Repair
0.00
1,708.00
0.001
1,708.00
?
-1,708.00
0.00
24
Paint
0.00
5,256.00
0.00
5,256.00
?
-5,256.00
0.00
25
Full Deck Waterproofing
0.00
5,985.00
0.00
5,985.00
?
-5.985.00
0.00
26
Concrete penetrating coating
0.00
1,710.00
HE
1,710.00
?
-1,710.00
0.00
27
lWall Anchors repairs
0.00
624.001
0.00
624.00
?
-624.00
0.00
PAGE 2 TOTAL: 1 0.001 15,933.001 0.001 1 15,933.00 ?-16,933.001 0.00
GRAND TOTAL: 1 0.001 226,623.821 0.001 1 226,623.82 ?-226,623.82 0.00
A=Line Item Number B=Brief Item Description C=Total Value of Item D=Total of D and E From Previous Appliration(s) (If Any) E=Total Work Completed For This Application
F=Materials Purchased and Stored for Project G=Total of All Work Completed and Materials Stored for Project H=Remaining Balance of Amount to Finish 1=Amount Withheld from G
TORGO SOFTWARE www.TorgoScfi are..m 01996-2013 ALL RIGHTS RESERVED