HomeMy WebLinkAboutPAYMENTG702 APPLICATION and CERTIFICATE for PAYMENT
To: SVO Managment, Inc. j
Project: Vistana Beach Club
Application No: 2
Distribution to:
9002 San Marco Building 1000
10740 S Ocean Drive
App. Date: December 23, 2015
® OWNER
Orlando, Florida 32819
Jensen Beach, Florida 34997
❑ CONSTRUCTION MGR.
From: Blue coast Construction
SCANNED
Period to:
❑ ARCHITECT
® CONTRACTOR
2587 SE Monroe st
BY
Project No:
® ENGINEER
Stuart, Florida 34997
St. Lucie County
Contract Date:
Contract For: Concrete Restoration Engineer: Florida Consulting Engineers
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 99,291.99
2. Net Change By Change Orders 12,486.17
3. CONTRACT SUM TO DATE 111,778.16
4. TOTAL COMPLETED AND STORED TO DATE 111,778.16
5. RETAINAGE:
a. of Completed Work
b. of Stored Material
TOTAL RETAINAGE
G. TOTAL EARNED LESS RETAINAGE
0.00
0.00
0.00
111.778.16
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 71,638.80
8. CURRENT PAYMENT DUE 40,139.36
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
Total approval this Month
12,486.17
0.00
TOTALS
12,486.17
0.00
NET CHANGES by Change Order
12,486.17
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 for Work for which previous Certificates -for Payym_:eF92 r — -s g an_1 paymen
received from the Owner. and that current Davmentrsi�wrt 1F eF�i ris1now du�V/ I I fill
CONTRACTOR:
FED , i3 REO
By: Date:
State of: I 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 www.TorgoSoftwa .o 01996-2013 ALL RIGHTS RESERVED
CONTINUATION SHEET G703 PROJECT: Vistana Beach Club
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing
i Contractor's signed Certification is attached.
j Use Column I on Contracts where variable retainage for line items may apply.
Blue coast Construction
Application No: 2
Page 1 of 1
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 feted
Materials
Stored i£ Used
Prior+ Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Period
1
Permit Fees
2,000.00
1,150.00
0.00
1,150.00
57.50
850.00
0.00
2
Mobolization
6,500.00
6.500.00
0.001
6,500.00
100.001
0.00
0.00
3
Column Repair
9,744.00
0.00
2,673.60
2,673.60
27.44
7,070.40
0.00
4
Ceiling Repair
6,287.20
6,236.67
3,639.89
9,876.56
157.09
-3,589.36
0.00
5
Edge Repair
21.560.00
11,408.10
531.63
11,939.73
55.38
9,620.27
0.00
6
Through Deck Repair
23.850.00
35,621.25
11,128.07
46,749.32
196.01
-22,899.32
0.00
7
Deck Repair
14.350.00
11,872.78
2,129.17
14.001.95
97.57
348.05
0.00
8
Rust spots
1,800.00
0.00
0.00
0.00
1,800.00
0.00
9
Steel Column
1,200.00
0.001
0.00
0.001
1.200.00
0.00
10
lWatertight Application
2,003.67
2,730.00
2.730.00
136.25
-726.33
0.00
11
Spray Deck Application
1,001.84
1,365.00
1,365.00
136.25
-363.16
0.00
12
Spray Deck Paint
7,896.00
7,200.00
7,200.00
91.19
696.00
0.00
13
Ceiling- Edge Wall Paint
1,099.28
0.00
0.00
0.00
1,099.28
0.00
14
Handrail paint
2,592.00
2,592.00
-2.592.00
15
Stack 05 paint
5,000.0
1
5,000.00
-5,000.00
GRAND TOTAL: 1 99,291.991 71.638.801 40.139.361 0.001 111,778.16 112.58-12,486.17 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
I
TORGO SOFTWARE w .TorgoSoflwam.wm 01996-2013 ALL RIGHTS RESERVED