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Home My WebLink AboutAPPLICATION AND CERTIFICATE FOR PAYMENTAA® �IA Document G702" -1992 Application and Certificate for Payment S ByYE-b St, Lucie Counti, TO OWNER: PROJECT: Island Dunes Oceanside I APPLICATION NO: 011 Distribution 8800 S. Ocean dr. PERIOD TO: OWNER: CONTRACT FOR: Concrete Restoration ARCHITECT: ❑ FROM VIA CONTRACT DATE: June 12, 2018 CONTRACTOR: ❑ CONTRACTOR: ARCHITECT: PROJECT NOS: Charles Darden P.E. #76910 / Special Forces Restoration and Construction FIELD: ❑ / Island Dunes Oceanside I condominium Association, OTHER: ❑ CONTRACTOR'S 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 Application p y completed in accordance with the Contract Documents, that all amounts have been paid Continuation Sheet, AIA Document G703, is attached. b the Contractor for Work for which previous Certificates for Payment were issued and 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 G on G703) 5. RETAINAGE: a. 0 %of Completed Work (Column D + E on G703) IL 0 % of Stored Material (Column F on G703) Y $225,678.00 payments received from the Owner, and that current payment shown herein is now due. $35,691.04 CONTR,-ACCTTOOR: ' $261,369.04 ,By: //�_• '�!':/�_�� Date: $231,899.96 State of - County of: 7L1R-c-f'c.� Subscribed and sworn to before ,o'i "I ry JODI LYNN CASTIGLIONE•BENTLEY ?. State o1 Florida- Glary Public $0.00 me this /3 day of c�u-.r-zr ,�D y°� ', .§ Commission NGG 153501 Commission Expires $0.00 Notary Public�4�r��t'jfJr*-ol ^"" November14.2021 Total Retainage (Lines 5a+5b or Total in Column I of G703) .................. $0.00 my L:ommissmn expires: 6. TOTAL EARNED LESS RETAINAGE..... .............................................................. S231,899.96 ARCHITECT'S CERTIFICATE FOR PA MENT (Line 4 Less Line 5 Total) In accordance with the Contract Documents, based on -site observations and the data 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................. $213,643.66 comprising this application, the Architect certifies to he Owner that to the best of the (Line 6 from prior Certificate) Architect's 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 9. CURRENT PAYMENT DUE.......................................................................... $IS 25f,.30 enticed to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED .....,...... .. ............. ....... ,,_..... ................... I ........ .._......... $18,256.30 (Line 3 less Line 6) $29A69.08 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $35,691.0 $0.06 Total approved this Month $0.01 $0.00 TOTALS $35,691. S0.60 NET CHANGES by Change Order $35,691.04 (ANach explanation if amount certified4d,frome amount applied. Initial all figureson this ApplicaNan «n 1 on ti Ca I donSanged to conform with the amount certified) ARECT•By: Date: This Certificate is not negotiable. ThERTIFIED is payable only to the Contractor named herein. Issuance, payment and ayment arc without prejudice to any rights of the Owner or Contractor under this Contract. ALA Document G702m -1902. Copyright@ 1953, 1963. 1965, 1971, 1978, 1983 and 1992 by The American Institute at Architects. All rights reserved. WARNING: This AIA}0 Document Is protected by U.S. f Copyright Law and Intamatlonal Treaties. Unauthorized reproduction or distribution of this AIA° Document, or any portion of it, may msuitln severe 00 and criminal penalties, and will be prosecuted to the maximum extant possible under the law. This document was produced by AIA software at 120:11 an 0611212018 under Order No. 8027207778 which expires on 05/03/2019, and Is not for resale. User Notes: (3BRADA38) AIA Document G702m =1992 Application and Certiff�ate for Payment TO OWNER: Q E PROJECT: Island Dunes Oceanside 1 LLi N a 8800 S. Ocean dr. > °'ij�oSy4 FROM U o VIA CONTRACTOR: LU v ARCHITECT: Q u J N APPLICATION NO: PERIOD TO: CONTRACT FOR: ' , , ¢ r1 k SSAµ v4.:W-"jc'E� ?rLJ 011 Concrete Restoration CONTRACT DATE: June 12, 2018 PROJECT NOS: Charles Darden P.E. #76910 / Special Forces Restoration and Construction / Island Dunes oceanside I condominium Association, Distribution OWNER: ARCHITECT: ❑ CONTRACTOR: ❑ FIELD: ❑ OTHER: ❑ CONTRACTOR'S 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 Continuation Sheet, for Document showG703is attached. 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 1. ORIGINAL CONTRACT SUM............................................................ I................... $225,678.00 payments received from the Owner, and that current payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS ....... ..(..............................)................. $35,691.04 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 t 2)............................................................ $261,369.04 _By: �%\� d� Date: (111all rf 4: TOTAL COMPLETED & STORED TO DATE Column G on G703 $231,899.96, State of 6. RETAINAGE: ' County of %Lilo-%rw Jbbl WNN CASTIOUONE.BENTLEY a. 0 /o of Completed Work Subscribed and sworn to before Stele of Florida -Notary Public (Column D +E on G703) , $0.00 me this �a day of �c-.t-� . e2.01r ?, i Commission # GG 153501 b.0 % of Stated Material `� My Commission Expires (Column F on G703) �$0.00 Notary Publictr�%��Lr-+lTd'^""` November 14, 2021 _._ Total Retainage (Lines 5a + 5b or Total in Column I of G703) .................. . $0.00 My Commission expires: 6. TOTAL EARNED LESS RETAINAGE.................................................................... $231,899.96 ARCHITECT'S CERTIFICATE FOR PA�fMENT (Line 4 Less Line 5 Total) In,accordance with the Contract Docmnents, based on -site observations and the data 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ $213,643.66 comprising this application, the Architect certifies to Owner that to the best of the (Line 6 from prior Certificate) Architect's 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 8. CURRENT PAYMENT DUE .............................. ........ $18,256.30 entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED...................................................................................... $18,256.30 (Line 3 less Line6)$29,469.08 (Attach explanation if amount certified di from the amount applied. Initial al! figures on this Application aa,J on ll#1 Cmquittation Sh Pet r aA changed to conform with the amount certified.) CHANGE ORDER SUMMARY ADDITIONS I DEDUCTIONS Total changes approved in previous months by Owner $35,691.04 $0.00 Total approved this Month $0.0 $0.00 TOTALS $35,691.041 $0.00 NET CHANGES by Change Order $35,691.04 By: This Certificate is not negotiable. The named herein. Issuance, payment and a the Owner or Contractor under this Con Date: P ?D is payable only to the Contractor are without prejudice to any rights of AIA Document G702TM -1992. Copyright @ 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document Is protected by U.S. Copyright Law and International Trestles. Unauthorized reproduction or distribution of this AIAo Document, or any portion of It, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 12:29:11 on 06/12/2018 under Order No. 8027207778 which expires on 05103/2019, and is not for resale. User Notes: (399ADA38)