HomeMy WebLinkAboutAPPLICATION AND CERTIFICATION FOR PAYMENTSCANNED
G702 APPLICATION AND CERTIFICATION
FOR PAYMENT
PAGE
TOOWNERI FisrtService
The Atrium l Condomialum Asso.
APPLICATION NO: 1
Distribution to:
3055 Cardinal Dr. Ste 200
2900 North AlA
3t, Luciecounty
DOWNER
Vero Beach, FL 32963
North Hutchinson Island
Application Date: 2/6/216
ENGINEER
PERIOD TO: 2/05/216
BCONTRACTOR
FROh) CONTRACTOR:
VIA ENGINEEiii 1ARVEnginneringlnc
0
Dnnlallo & Associates, Inc.
1835 20th streeat
NOT A LUMP SUM BID: Tbo amountis Hosed
2708 N. Australian Ave., Ste 9
Vero Beach,FL 32960
plan estimated quantities listed In Exhibit Quantity Schedule, The amount paid
West Phlm Beach, FI 33407
will be based upon actual quantities/w6rk performed at rates In Exhibit A.
CONTRACT:. Concrete Restoration Repairs
CONTRACT DATE:
ICTOR'SAPPLICATION FOR PAYMENT
The undersigned Contractor certifies that tothe best ofthe contractor's knowledge,
Is made for payment, as shoym below, in connection with the Contract.
information and belief the Work covered by this Application for Payment has been
i Sheet, Sheet G703, is Attached.
completed in accordance with the Contract Dectiments, that all amounts have been paid by
the Contractgr for Work for which previous CefOficates for Payment were isyued and
payments rpceived from the Owner, and that current payment shown herein Is now due.
1. ORIGINAL CONTRACT SUM
2. Net change by Change Orders
3. CONTRACT' SUM TO DATE (Line 1 t 2)
4. TOTAL COMPLETED & STORED TO
DATE (Column 12 on G703)
S. 110AINAGE:
a. SO %of Completed Work
b. _ %of Stored Material
Total Retainage (Lines 5g y Sh or
Total in Column 15 of9705)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 Less Line 5 Total)
7. LEE$PRGVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Certificate)
B. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAI
(Line 3 less Line 6)
$, 386.00
$, 0.00
$ 386.00
$. 386.00
State a(f .. ,m„=,.,, _ Florida
SubsFrided and sworn to before me i•vn'+,py, qG ALA, I$
Notary POhlio:+' _ M �Ot 437;.
My Cammisstan expires: =x'•. t.e EX -S: November 5, 261r. I
$ 0.00 ENGINFER'$ CERTIFICATE FOR PAYMENT ---`---- "`�""
$ 386.00 In acCordat" wlth the Contract Documents, based on on -site observations and the data
comprislpa the application, the Engineer certifies to the Owner that to the pest of the
Engkipgr's knowledge, information and belief the Work has progr@sspd as Indicated,
$, the gpailty of the Work is in accordance with the Contract Documents, and the Contractor
$ 386.00 is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED........... $
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved
In Previous months by Owilor
Total approved this Month
TOTALS
NET CHANGES by Change order
$0.00
(Attach exp1a0atlpn ff amount certified d*Fs from the amount applied, initial oil figures on this
Appllentloo and on the Continuation Sheet that are changed to conform with the amount certified.)
ENGINEER:
By:
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
Date: 2/05/216
County of Palm Beach
Date:
CONTINUA TION SHEET G703
PAGE 1 OF VARIES
Document 0702 APPLICATION AND CERTIFICATE FOR PAYMENT, contslning
- APPLICATION NO: 1
ContmetdPs signed Certification isatmched.
APPLICATION DATE 2/5/2016
PERIOD TO: 2/$/2016
Use Column i on Contracts where variable remlmme for line items may apply
PROJECT NO: The Atrlum
2
3
4.
5
6
7 8 9
10 11
12
13
14
IS
DESCRIPTION OF WORK
SCHEDULED
WDRKCOMPLCTtO
Value Comleted
pleted
%
RAIUICH
REraINAEE
FROMPREVIOUS
THISP6N09
Toral
PDOMPPEVIOBS
THIS PERIOD
VALUE
MFINISH
U'VAPNBLE
APPLICATION
APPLICATION
:an:d$to.rjgo
RATE)
t
IJel
Price
3-5 -
7.0
7-5
8"5
i1
6-12
C.0 2 Edge 6" 3rd floor
1.00
LE
$110.00
$110.00
1:00
$0.00
$110.00
$110,00
100.00%
$0.00
$0.00
C,01 Edge 6" 2nd floor
2.00
St
$110.00
$220.00
2.00
$0.40
$220.00
$220.00
100.00%
$0,00
$0.00
CA 2 Rust spot
2.00
ea
$28.00
$$6,00
2.00
$0.00
$56.00
$56,00
100.00%
$0,00
$0.00
v
GRAND TOTALS
$306.00'
$0.00
$386.00
$386.00
100.00%1
$0,00
$0.00