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HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENTG732 CMa (formerly G702 CMa) APPLICATION and CERTIFICATE for PAYMENT To: Islaqnd Crest Condominium Project: Island Crest Concrete restoration Application No: 4 Distribution to: 10680 South Ocean Blvd. App. Date: January 19, 2017. ® OWNER Jensen Beach, FL 31957 ❑-CONSTRUCTION MGR. From: Blue coast Construction 1Y� (�1 � © — ��1 �D Period to: El ARCHITECT CONTRACTOR 2587 SE Monroe st "-k- - Project No: El OTHER Stuart, Florida 34997 Contract Date: Contract For: Concrete RestorationConstruction Manager: CSM Engineering, LLC Architect: 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 t25,225.00 2. Net Change By Change Orders 97941.57 3. CONTRACT SUM TO DATE 135,166,57 4. TOTAL COMPLETED AND STORED TO DATE 5. RETAINAGE a. of Completed Work b. of Stored Material TOTAL RETAINAGE 6. TOTAL EARNED LESS RETAINAGE o:oo 0.00 0.00 135,166.57 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 122,315,56 8. CURRENT PAYMENT DUE 12,85L01 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 9,941.57 0.00 Total approval this Month 0.00 0.00 TOTALS 9,941.57 0.00 NET CHANGES by Change Order 9,941..57 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 Payment were: issued and payments received from the Owner, and that current payment shown herein is now due. SC BNNED CONTRACTOR By: t .. f_uCi — 3 at Count y f: Subscribed and'.. sworn before.me this dayof The above personally appeared ibefore 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 affinnedto 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: CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Construction Manager and Architect certify to the Owner that to the best of their knowledge, information and belief the Work has progressed asindicated, 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 CONSTRUCTION MANAGER: By: Date: ARCHITECT: 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. �4 s CAUTION: You should use an original document which has this caution printed in red, An original assures_that..changes willnot be obscured as may occur when documents:are. reproduced. TORGO SOFTWARE ;vmxTorgoSOMrdre.wm4199G2013 ALL RIGHTS RESERVE15-._-1..--; ,, ._. i:.mi . ,r. s.:: ,. <.::.:1,n. 1. ._, •..,._•., . ,.. -d. wiz utvia (Tormeny hfuz Gmaj ArrLlldi I Ivry dflU t,rzm I IriuA I C IOl r/AT IVICIV I To: Islagnd Crest Condominium Project: Island Crest Concrete restoration Application No: 4 Distribution to: 10680 South Ocean Blvd. App. Date: January 1g, 2017 ® OWNER Jensen Beach, FL 31957 SCANNED ❑ CONSTRUCTION MGR. From: Blue coast Construction J Period to: ❑ ARCHITECT BY ® CONTRACTOR 2587 BE Monroe at St. Lucie Cnitnt� Project No: ❑ OTHER Stuart, Florida 34997 Contract Date: Contract For: Concrete Restoration Construction Manager: CSM Engineering, LLC Architect: APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. Inforrmp�ation and belief the Work covered by this Application for Payment has been completed Continuation Sheet, G703, is attached. In aEcardance 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 1. ORIGINAL CONTRACT SUM 125,225 0 r0 received from the Owner, and that current payw"a'"Ianwahar6l&Is 2. Net Change By Change Orders 9,941.57 3. CONTRACT SUM TO DATE 135,166.57 4. TOTAL COMPLETED AND STORED TO DATE 135,166.57 5. RETAINAGE: a. of Completed Work b. of Stored Material TOTAL RETAINAGE 6. TOTAL EARNED LESS RETAINAGE 0.00 0.00 0.00 135,166.57 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 122,315.56 8. CURRENT PAYMENT DUE 12,851.01 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 9,941.57 0.00 Total approval this Month 0.00 0.00 TOTALS 9,941.57 0.00 NET CHANGES by Change Order 9,941.57 CONTRACTOR: By: ERICR RNILUPS Notary PuSllc, SZ of Florida Commi irr � ^ I'er�mm. e State ��,a J_ County of: e rTd/�yyl r Subscribed and sworn before me this _[hn day of V(Y r�2 The above personally appeared before me, the undersigned notary public, and provided satisfactory oviden f identification to be the person who signed this document in my presence and re o a to me th h contents of this document are truthful and accurate to th a s/her kn w Ilef. � Notary Publl A A mission expires:L/)J.' In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Construction Manager and Architect certify to the Owner that to the best of their 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 CONSTRUCTION MANAGER: By: By: Date: 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 w .TorgoSoftware.=01996-2d13 ALL RIGHTS RESERVED r SHEET G703 PROJECT: Island Crest Concrete restoration Blue coast Construction Page 1 of 1 702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing signed Certification is attached. Use Column I on Contracts where variable retainage for line items may apply. Application No: 4 App. Date: January1 §, 2017 Period to: Project No: A B C D E F G H I Item # Description of Work Schedule of Values Work Com Ieted. Materials Stored & Used Prior + Current Total Completed and Stored To Date % Balance to Finish RetainageF From Previous Application(s) This Pgriod 1 Mobolization 3,000.00 3,000.00 0.00 3,0130.00 100.00 0.00 0.00 2 Demobilizatio 2,000.00 2,000.00 0.00 2,000.00 100.00 0.00 0.0 3 Permit Fees 1,666.56 1,656.56 0.001 1,656.56 100.00 0.00 0. 4 Deck'Spallin9 0.00 14,577.75 0.001 14,57765 ? -14,577.75 U. 5 Concrete Cotu n Repair 10,920.00 1,359.80 0.00 1,359.80 12.45 9,560.20 0.00 6 Concrete Deck Slab Repair (Full Depth) 38,880.00 45,309.60 0.00 45,309.60 116.54 -6.429.60 0.00 7 Concrete Edge Repairs 0.00 22,668.36 0.00 22,668.36 ? -22,668.360.00 7.5 Concrete Deck Slab Repair (Overhead) 41,565.00 0.00 0.00 0.00 6.00 41,565.00 0.00 12 incAnodes 10,000.00 6,500.00 0.00 6,500.00 65.00 3,500.00 0.00 16 Wheather Wall installation & Removal 5,200.00 7,960.00 0.00 7,960.00 153.08 2,760.00 0.00 26 Remove, store:, & reinstall Glass Doors 7,150.00 6,160.00 0.00 6,160.00 86.15 990.00 0.00 27 Remove, store &reinstall Railing 2,100.00 11,370.00 0.00 11,370.00 541.43 -9,270.0 0.00 138 Unit 1201 Ove racl Repair 3,060.00 2,040.00 0.00 2,040.00 66.67 1,020.00 0.00 39 Lift for1201 1,350.00 1,350.00 0.00 1,350.00 106.00 0.001 0.00 40 Hook Bars for ail post 0.00 2,400.00 0.00 2,400.00 ? -2,400.001 0.00 41 Tile Removal 0.00 11750.00 0.001 1,750.00 ? -1,750.00 0.0 42 Preparing and,testing concrete 0.00 1,800.00 0.001 1,800.00 ? -1,800.0( 0 43 Painting 0.00 2,175.00 0.00l 2,175.00 ? -2,175.0( 0.0 44 Waterproofing,under Sliders Tracks 0.00 589.50 0.001 589.50 ? -580.50 0.00 45 R & R Floor O erlay 0.00 500.00 0.001 500.00 ? -500.00 0.00 GRAND TOTAL: 1 126,881.561 135,166.571 0.001 1 135,166.5 106.53-8,285.01 0.00 F=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 Fpr This Application =Materials Purchased and Stored for Project 0--Total of All Work Completed and Materials Stored for Project H=Remaining t;alance of Amount to Finish 1=Amount Withheld from G TORGO SOFTWARE ~.TorgoSoft a .o 0199662013 ALL RIGHTS RESERVED