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HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENTSCANNED G732 CMa (formerly G702 CMa) APPLICATION and CERTIFICATE for PAYMENT St. Lu BY I - To: Oceana North I Condominium Project: 'Oceana North I Application No: 5 .Distribution to: 9940 South Ocean Blvd. - 0 OWNER App, Date; April 11, 2017 Jensen Beach, FL31957 /ram- T{� .!/�') %- ❑ CONSTRUCTION MGR. TECT From: Blue coast Construction ( fir( �'T "'='-• ©— Period ® CONTRACTOR 2587 SE Monroe sl Project'No. '❑ OTHER Stuart, Florida 34997 - Contract Date: Contract For: Concrete Restoration Construction Manages 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. information and belief the Work covered. by this Application for Payment has been completed PP P Y in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, G703, is attached. Contractor for Work for which, previous Certificates for Payment were issued and payments 1. ORIGINAL CONTRACT SUM: 105,933:00 received from the Owner, and that current payment shown herein is now due. 2. Net Change By Change Orders 112,4T1:08 CONTRACTO 3. CONTRACT SUM TO DATE 218,344.08 gy; t 4. TOTAL COMPLETED AND STORED TO DATE 8234&,G$ 5. RETAINAGE: State of: oun y of: a. of Completed Work 0:00 Subscribed and swom before me this -day of b: of Stored Material 0:00 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 TOTAL RETAINAGE 0 0D presence and swore or affirmed tome that the contents of this document are truthful and accurate to the best of his/her knowledge and belief. 6. TOTAL EARNED LESS RETAINAGE 21a,344:03 Notary Public My Commissionexpires: 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 198,15s.35 CERTIFICATE FOR PAYMENT 8. CURRENT PAYMENT DUE 20;185.73 In accordance with the Contract Documents; based on on -site observations and the data 9.BALANCETOFINISH,INCLUDINGRETAINAGE 0.00 comprising this application, the Construction Manager and Architect certify to the Owner that to the best of theirknowledge; 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. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 112,411.08 0.00 Total approval this Month 0:00 0.00 TOTALS 112,411.08 0.00 NET CHANGES by Change Order 112,411.08 AMOUNT CERTIFIED CONSTRUCTION MANAGER: By; Date: ARCHITECT: 2 iBY: Date: y� si / This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the /2agpoc�s 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: printedin: red.An original assures that changes will not be obscured as. may.ogcu[,when documents are reproduced. TORGO aOhTWARE vrvrri.76rgoSd4ware.com 61495-2013 ALL RIGHTS RESERVED..t>'.,,:G.-G.�...T,rF;¢pi„r<.�=.ii,�a.2r_;':%„i. ,_+Tti;'•� ,'i .4. ,,,.,, . -:c� ,,' :�L ,.. .: ry