HomeMy WebLinkAboutCERTIFICATE FOR PAYMENTG702 APPLI(:ATION and CERTIFICATE for PAYMENT
To: Turtle Reef Condominium
10800 S Ocean Drive
Jensen Beach, Florida
From: Blue coast Construction
2587 SE Monroe at
Stuart, Florida 34997
Contract For: Concrete Restoration
Project: Turtle Reef Stack No. 2 to 10
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
0.00
2. Net Change By Change Orders
161,382.90
3. CONTRACT SUM TO DATE
161,382,90
4. TOTAL COMPLETED AND STORED TO DATE
161,382.90
5. RETAINAGE:
a. of Completed Work
b. of Stored Material
TOTAL RETAINAGE
6. TOTAL EARNED LESS RETAINAGE
0.00
0.00
0.00
161,382.90
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 141,563.20
B. CURRENT PAYMENT DUE 19-819.70
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
161,382.90
0.00
Total approval this Month
0.00
0.00
TOTALS
161,382.90
0.00
NET CHANGES by Change Order
161,382.90
Application No: 9
App. Date: October 12, 2018
Period to:
Project No:
Contract Date:
Distribution to:
❑ OWNER
❑ CONSTRUCTION MGR.
❑ ARCHITECT
❑ CONTRACTOR
® ENGINEER
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 amounts 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 herein is now due.
SCANNED
CONTRACTOR: BY
By: Date: St Lucie County
State of: County of:
Subscribed and swom 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
Engineer's 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 cerfified.)
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.
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CAUTION: You should use an oricinal document which has this caution orinted in red. An oriainal assures that chances will not be obscured as may occur when documents are reproduced.
CONTINUATION SHEET G703 PROJECT: Turtle Reef Stack No. 2 to 10 Blue coast Construction Page 1 of 1
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: 9
App. Date: October 12, 2018
Period to:
Project No:
A
B
C
D
I E
F
G
H
I
Item
#
Description of Work
Schedule
of
Values
Work Completed
Materials
Stored & Used
Prior+ Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Period
1
Edge Repair for Full Depth
0.00
43,171.20
0.00
43,171.20
?
-43,171.20
0.00
2
Half Deck repairs
0.00
8,679.30
0.00
8,679.30
?
-8,679.30
0.00
3
Full Depth Repair
0.00
16,643.70
0.00
16,643.70
?
-16,643.70
0.00
4
Ceiling Spalls (+/-3 inches)
0.00
16,606.80
0.00
16,606.80
?
-16,606.80
0.00
5
Beam Spalls (Lx6"x6")
0.00
569.70
0.00
569.70
?
-569.70
0.00
6
Column Spells (Lx6"x6")
0.00
4,494.201
0.00
4,494.20
?
-4,494.20
0.00
7
Rust Spots
0.00
0.00
0.00
?
0.00
0.00
8
Anchor Removal
0.00
12,976.00
0.00
12,976.00
?
-12,976.00
0.00
9
Gardrail post Pocket repairs
0.00
0.00
0.00
0.00
?
0.00
0.00
10
Concrete Beam Repair
0.00
0.00
0.00
0.00
?
0.00
0.00
11
Concrete Column Repair
0.00
40,716.00
0.00
40,716.00
?
-40,716.00
0.00
12
Drip Edge Installation
0.00
0.00
0.00
0.00
?
0.00
0.00
13
Cathodic Protection
0.00
0.001
0.00
0.00
?
0.00
0.00
14 lKnee
Wall Replacement
0.00
0.00
0.00
0.00
?
0.00
0.00
15
Sika Ferroguard 903
0.00
13,876.00
0.00
13,876.00
?
-13,876.00
0.00
16
Dowels (Change order)
0.00
3,650.00
0.00
3,660.00
?
-3,650.00
0.00
17
MMFFX Steel (Change order)
0.00
0.00
0.00
0.00
?
0.00
0.00
18
Flashpatching
GRAND TOTAL: 1 0.001 161,382.901 0.001 1 161,382.90 ?-161,382.90 0.00
A=Line Item Number B=Brief Item Description C=Total Value of Item D=Total of D and E From PreviousApplication(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