HomeMy WebLinkAboutAPPLICATION AND CERTIFICATION FOR PAYMENT6702 APPLICATION AND CERTIFICATION FOR PAYMENT
PAGE
TODWNERI Princess Condominium Unit 203 APPLICATION NO: d Distribution to:
9650 South Ocean Dr. RETAINAGE •J
Jensen Beach, FL 34957 = OWNER
FROM CONTRACTOR:
08/17/16 ENGINEER
08/17/16 =CONTRACTOR
Damello &Associates, Inc. 2081SE Ocean Dr. Suite IA NOT LUMP SUM BID: The amount is based
2709 N. Australian Ave., Ste 9 Stuart, FL 34996 upon estimated quantlties listed in Ekhiblt A Quantity Schedule. The amount paid
West Palm Beach, FI 33407 will be based upon actual quan8ties/work performed at rates In Hxblbit A.
CONTRACT: Concrete Restoration Repairs CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that totile best ofthe Contractor's knowledge,
Application is made for payment; as shown below, in connection with the Contract Information and belief the Work covered by this Application for Payment has been S�`pNN
Continuation Sheet Sheet G703,1sattached completed In accordance with the Contract Docu th II
I. ORIGINAL CONTRACT SUM
2. Net change by Change Orders
3. CONTRACT SUM TO DATE (Line 1 t 2)
4. TOTAL GOMPLETED & STORED TO
DATE (Column 12 on G703)
S. RETAINAGE:
a. 10 %of Completed Work
Jr. —. %of Stored Material
Total Reminage (Lines So s Sir or
Total in Column 15 of0703)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 Less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. OALANGE TO FINISH, INCLUDING RETAINAI
(Linn 3less Line 6)
Applicatlon Date:
PERIOD TO:
VIA ENGINEER! CSM Engineering
menrs, ata amounts have been paid by C� the Cpntractar for Work for which previous Certificates for Payment ware issued and { B Payments received from the Owner, and that current payment shown herein is now due. Sl. Lu
$. 5,187.DD cre 06
unfv
$; ,(1,033.35) CONTRACTOR:
$ 4,153.65 -
$, 4,153.65/
Ey
Dam: OB/17/16
State of: ,e yet `. .riif:+dlP.f,OiRs: `�S4F!A
Suhseribed andaWorn to before me this .I s�� r I : �•o Ida County of: Palm Beach
)w,_ -? 1a? MY ; %? •.ISS. )\ + F L"73
_ Notary Public;
MY Commission expires:
a. 4,153.65 In accordance With the Contract Documents, hosed on on -site observations and the data
comprising the application, the Engineee certifies to the Owner that to the best of the
Engineer's knowledge, Information and belief the Work has progressed as indicated,
$ 3,940.05 the quality of the Work is in accordancd with the Contract Documents, and the Contractor
$. 2,13.60 Is entitled to payment of the AMOUNT CERTIFIED.
$ 0.00
AMOUNT CERTIFIED........... $
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved
In ptevinils months by Owner
$300.17
Total approved this Month
$1,333.52
TOTALS
$300.11
$1.333.52
NET CHANGES by Change Order
($1,033,35)
(Attach Pxplonatfon Ifamount certified dtTers from the amount applied, Iniffal ngffgures on this
Applieatfan and on the Continuation Sheet that are changed to conforfra wffh the amount certified.)
ENGINEER:
By:
This CerUUcate 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.
N
I
4
E
E
7
2
9
l0
11
la
13
14
1s
16
Si
19
19
20
21
22
23
24
2s
26
2i
28
29
30
31
32
33
34
35
6
14
CONTINVATiONSBEEr6703
PAGE 1 Document G702 APPLICATIONgND CERTIFICATE FOR PAYMENT, containing DF WAGESAPPLICATION NO: 2
ContYacrofs signed Certlflratlon Is attached. APPLICATION DATE: 8/17/2016
Use Column Inv PERIOD TO: 8/17/2016
2
DESCRIPTION OFWORK
3
4
S
6
SCHEDULED
VALUE
7
8.
wank COMPLETED
9
30
Value Cam
IS
leted
PROJECT
12
Total CoinPleted
and Storage
NO:
13
%
Prineess Condominium
14
anuxcA
TO FINISe
IS
ALTAIxAee
(IFVAAUBLE
PROM PAAVIOU.
APPLICATION
THIS PERIOD
Total
room Pam"ous
WIS PERIOD
APPLICATION
PATB)
QY
Urd I
Frk¢
3.5
7,8
7.4
8•5
10s11
6.12
Mub(lizatlon
Demobilization
1
L9
$300.00
$300.00
1.00
1.00
$300.00
$0.00
$300.00
100%
$0,q0
$0.00
Permitting at Cost
1
Ts
$390.00
$300.00
1,00
1.00
$300,00
$0.00
$300.00
100%
$0.00
Concrete Beam Repair
1
OF
$300.17
$300.17
1.00
1.00
$300.17
$0.00
$300.17
100%
$0.00
$0.00
Concrete Column Repair
m'
$0.00
0.00
$9.00
$0.00
$0.00
$0,00
: a
Cdncrete Deck Slab Repair (Full 0epth)
SF
$0.00
0.00
$0.00
$0.00
$0.00
$0,00
'I
Concrem Deck Slab Repair (overhead)
21
SF
$91.00
$0,00
$1,911.00
12,28
0.00
$0.00
$0.00
$0.00
$0.00
w.uo
Concrete Deck Slab Repair (Up to 50%Depth)
12.28
$1,117.48
$0.00
$1,117.48
58%
$793.52
$0.00
Concrete Wall Repair
SF
$0.00
0.00
$0.00
$0.00
$0,00
0.00
$0.00
Concrete Stair Repair
CF
$0.00
0.00
$0.00
$0.00
$0,00
$0.00
$0.00
Concrete Deck Slab Repair(4" Thick Parking Roof)
CF
SF
$0.00
$0.00
0.00
$0,00
$0.00
$0,00
$0.00
$0.00
Epoxy Injection overhead (LF)
LF
0.00
$0.00
$0.00
$0,00
$O,QO
$0.00
Epoxy injection Vertical (LF)
LF
$0.00
0.00
$0,00
$0.00
$0,00
$0.00
$0.00
Hhilzontal cracks -gravity feed (LP)
LF
$0.00
0.00
$0,00
$0.00
$0.00
$0,00
$0.00
Gelvashield XP embedded anodes
12
EA
$43.00
$0.00
$540.00
0.00
$0,00
$0.00
$0,00
30,90
$0.00
Migrating Corrosion Inhibitor (Sika Ferrogard 903)
SF
$0.00
0.00
$0,00
$0.00
$0.00
0.00%
$540.00
$0.00
Waterproofing (BASF SONOSHIRLD SONOGUARD).
SF
$0.00
0.00
$0,00
$0.00
$0.00
$9.00
$0.00
Painting.
0.00
$0.00
$0.00
$0,00
$0.00
$0.00
Reslapo open balcony
SF
$0.00
0.00
$0,00
$6.60"
_ $0.00
$0.00
$0.00
Stucco repairs
SF
$0.00
0.00
$0.00
$0.00
$0,00
$OQO
,
$0.00
Preparatlon &testing of concrete cylinders.
cylinders
SF
AA
$0.00
000
.
$q00
$000
,
$0.00
$0,00
$0.00
Weather Wall Installation & Removal
18
LF
$52.00
$0.00
$936.00
18,00
0.00
18.00
$0,00
$936.00
$0.00
$0.00
$0.00
$936,00
-
loll%
'' $0,110
$0.00
Remove& dispose of Glass Doors
LF
$0.00
$O,qO
$93.60
93.60
Remove& dispose of Glass Window Systems
LF
$0.00
0.00
$0,00
$0.00
$0.00
$0,00
Remove &dispose of Rail &Screen
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Remove& dispose of Accordion Hurricane Shutters
LF
$0.00
0.00
$0.00
$0.00
$0,00
X00
'I
Remove& dispose of Electrfe RR11-.Up Hurrincane Shutters
LF
LF
$0.00
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
=`I
Remove&dispose of Manual Rpll=Up Hurrincane Shutters
LF
$0.00
0.00
$0,00
$0.00
$0.00
$0.00
$0.001
Remove; store, & reinstall Glass Doors
15
LF
$80,00
$1,200.00
15,00
0.00
15.00
$0,00
$1120400
$0.00
$0.00
$0.00
$1,200,00
100%
$0,00
$0,00
$0.00
$120.00
Remove, store, & reinstall Class WlpdoW Systems
LF
$0.00
0.00
$0100
$0.00
$0.00
Remove, store, &reinstall Rail &Screen
LF
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Remove, store,& reinstall Accordion Hurrincane Shutters
LF
$0.00
0.00
$0,00
$0.00
$0.00
Remove, store, & reinstall Electric Roll -Up Hurrincane Shutters
LF
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Remove, store, & reinstall Manual Roll -,Up Hurrincane Shutters
LF
$0.00
$0.00
$0.00
$0.00
$0.00
Tile Removal
0.00
$0.00
$0.00
$0,00
$0.00
$0.00
Install New Tile
SF
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CHANGE ORDER No. 1-CNEDITS
SF
$0.00
0.00
$0.00
$0.00
$0.00
$O, pO
$0.00
Concrete Deck Slab Repair (Overhead)
g
SF
$91,00
($793.52)
0.00
$0.00
$0.00
$0.00
$9.00
$0.00
Galvashleld XP embedded anodes
12
EA
$45.00
($540.00)
0.00%
($793.52)
($540.00)
GRAND TOTAIS
$4,153.65
$4,153.65
$0.00
$4,153.65
300%
$p.00
$213.60