HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENTG732 CMa (formerly G702
To: Cessna North 11Condominium
9900 South Ocean Blvd.
Jensen Beach, FL 31957(_�
From:. Blue coast Construction
2587 SE Monroe st
Stuart, Florida34997
Contract For: Concrete Restoration
APPLICATION and CERTIFICATE for PAYMENT
Project: Oceana North 11
Construction
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
1 272,803.00
2. Net Change By Change Orders
217,423.20
3. CONTRACT SUM TO DATE
490,226.20
4. TOTAL COMPLETED AND STORED TO DATE
5. RETAINAGE:
a. of Completed Work
46,181.41
b. of Stored Material
0.00
TOTAL RETAINAGE
46,138.43
6. TOTAL EARNED LESS RETAINAGE
444,087.77
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT 426,6D1.74
8. CURRENT PAYMENT DUE
17,486.03
9. BALANCE TO FINISH, INCLUDING RETAINAGE 1 46,138.48
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
199,M2.34
0.00
Total approval this Month
18.340.86
0.00
TOTALS
217,423.20
0.00
NET CHANGES by Change Order
217,423.20
Application No: 5
App. Date: April 26, 2017
P nod to:
B oject No:
(tract Date:
LLC
Architect:
Distribution to:
I� OWNER SCANNED
❑ CONSTRUCTION MGR.BY
❑ ARCHITECT St. Lucie County
® CONTRACTOR l�
❑ OTHER
The undersigned. Contractor certifies that tothe 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.
3 let
® rfl-. G
State of., County of.
Subscribed and swom before me this dayof
The above personally appeared before me, the undersigned notary public, and provided
satisfactory evidence of identification to be theperson 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 histher 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 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:
us
ARCHITECT:
Date:
By: Date:
i ��_2 ?26 9.
j /J ��� This Certificate is not negotiable. The AMOUNTCERTIFlED is payable only to the
�iVK C iOp%fJ 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 which has has this caution printed in red. An'originalassures that changes will not be obscured as may occur when documents are reproduced.
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