HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENT'G702:�,_,_ " 'APPLIdATION and CERTIFICATE for PAYMENT
To: Oceamise Condominium
10310 S Ocean Drive
Jensen Beach, Florida
From: Blue coast Construction
2587 SE Monroe at
Stuart, Florida 34997
Contract For: Concrete Restoration
APPLICATION FOR PAYMENT
Project: Oceanrise condominium Concrete ApplicationNo: 3
Restoration SCANNED App. Date: March 13, 2018
BY Period to:
St. Lucie County Project No:
Contract Date:
Engineer: Mathers Engineering
Application is made for payment, as shown below, in connection with the Contract
Continuation Sheet, G703, is attached.
1. ORIGINAL CONTRACT SUM
2. Net Change By Change Orders
168,002,88]
3. CONTRACT SUM TO DATE
168.002,881
4. TOTAL COMPLETED AND STORED TO
DATE 168,00
5. RETAINAGE:
a. of Completed Work
b. of Stored Material
TOTAL RETAINAGE
0,001
6. TOTAL EARNED LESS RETAINAGE
168,002.88
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT
8. CURRENT PAYMENT DUE
14,532.93
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0,001
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
168,002.88
0.00
Total approval this Month
0.00
0.00
TOTALS
168,002.88
0.00
NET CHANGES by Change Order
168,002.88
Distribution to:
0 OWNER
0 CONSTRUCTION MGR.
L1 ARCHITECT
L1 CONTRACTOR
Z ENGINEER
The undersigned Contractor certifies that to the 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.
CONTRACTOR:
By:
Date:
State of'. County of
Subscribed and sworn before me this -dayof
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
presence and swore or affirmed to me that the contents of this document are truthful and
accurate to the best of his/her knowledge and belief.
Notary Public: My Commission expires:
ENGINEER'S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data
comprising this application, the Engineer certifies to the Owner that to the best of the
Engineer'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
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED
(Attach explanation if amount certified differs from the amount applied for. Initial all figures
on this Application and an the Continuation Sheet that are changed to conform to the
amount oertified.)
ENGINEER
By: Date:
This Certificate is not negoriable. 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.
CAUTION: You should use an original document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced.
"CAUTION: You should use an original document which has his.caution printed in red. An original assures that changes will not be obscured as may occurwhen documents are reproduced.
CONTINUATION SHEET G703 PROJECT. Ocearrise condominium Concrete Restoration Blue coast Construction
Page 1 of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing
Application No: 3
Contractor's signed Certification is attached.
App. Date: March 13, 2018
Use Column I on Contracts where variable retainage for line items may apply.
Period to:
Project No:
A
B
C
D
E
F
G
H
I
Item
#
Description of Work
Schedule
of
Values
Work C
Materials
Stored & Used
Prior + Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Per ad
0.1
Permit
2,288.13
2,288.13
-2,288.13
0.2
Mobilization
5,000.00
5,000.00
-5,000.00
1
Edge Repair for Full Depth
0.00
11,660.00
0.00
11,660.00
?1
-11,660.00
0.00
2
Half Deck repairs
0.00
2,921.80
0.00
2,921.80
?
-2,921.80
0.00
3
Full Depth Repair
0.00
74,577.60,
0.00
74,577.60
?
-74,577.60
0.00
4
#5 Dowels up to 12"
0.00
17,400.00
0.00
17,400.00
?
-17,400.00
0.00
5
Reinforcing #3 bars MMFX
6
Reinforcing #4 bars MMFX
0.00
2,381.30
0.00
2,381.30
?
-2,381.30
0.00
7
Reinforcing #5 bars MMFX
0.00
3,981.25
0.00
3,981.25
?
-3,981.25
0.00
8
Ceiling Spells (+/4 inches)
0.00
0.00
0.00
0.00
?,
0.00
0.00
9
Beam Spalls (Lx6"x6")
0.00
0.00
0.00
0.00
?
0.00
0.00
10
Column Spalls (Lx6"x6")
0.00
0.00,
0.00
0.00
?
0.00
0.00
11
Stucco repairs
0.00
0.00
0.00
0.00
?
0.00
0.00
12
Shutters Removal
0.00
4,914.00
0.00
4,914.00
?
-4,914.00
0.00,
13
Shutters Re -Install
216.00
4,698.00
4,914.00
-4,914.00
14
Doo Frame Removal/Re-Install
1,200.00
2,520.00
3,720.00
-3,720.00
15
Doo Framing bottom Track Removal
0.00
0.00
0.00
0.00
9
-
0!2
0.00
16
Tile Removal / old membrane
0.00
174.90
0.00
174.90
-17� go
0.00
17
Rust Spots
1 0.00,
540.00,
0.00,
1 540.001
?1
-540.00
0.00
PAGE 1 TOTAL: 1 0.001 127,254.981 7,218.001 1 134,472.981 ?1 -134,472.981 0.0
A=Une Item Number B=Brlef Item Description C=Total Value of Item D=Total of D and E From Previous Application(s) (if Any) E=Total Work Completed For This Application
F=Materials Purchased and Stored for Project G=.Total of All Work Completed and Materials Stored for Project H=Remaining Balance of Amount to Finish I=Amount Withheld from G
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CONTINUATION SHEET G703 PROJECT., Oceanrlse condominium Concrete Restoration Blue coast Construction Page 2 of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Application No: 3
Contractor's signed Certification is attached. App. Date: March 13, 2018
Use Column I on Contracts where variable retainage for line items may apply. Period to:
Project No:
A
B
C
D
I E
F
G
H
I
Item
Description of Work
Schedule
of
Values
Work C mpleted
Materials
Stored & Used
Prior + Current
Total Completed
and Stored
To Date
%
Balance
to Finish
1
Retainage
From Previous
Application(s)
This
Period
18
Wall Cracks (Caulking)
0.00
0.00
0.00
0.00
?
0.00
0.00
19
Gardrail post Pocket repairs
0.00
0.00
0.00
0.00
?
0.00
0.00
20
Interior Dust Wall Installation and Removal
0.00
3,440.00
0.00
3,440.00
?
.3,440.00
0.00
21
Gardrall Screen Removal / Re -install
0.00
4,700.00
0.00
4,700.00
?
-4,700.00
0.00
22
Concrete Beam Repair
0.00
3,055.00
0.00
3,055.00
?
-3,055.00
0.00
23
Concrete Column Repair
0.00
7,134.40
0.00
7,134.40
?
-7,134.40
0.00
25
Grinding Decks
0.00
2,358.00.
0.00
2,358.00
?.
-2,358.00
0.00
26
Drip Edge Installation
0.00
196.50
0.00
196.50
?1
-196.50
0.00
27
Winclow Barrier during Hurricane
0.00
0.00
0.00
0.00
?
0.00
0.00
28
Cathodic Protection
0.00
0.00
0.00
1 0.00
?
0.00
0.00
29
Screen Anchor Removal
0.00
0.00
0.00
R3,5000
0.00
?
0.00
0.00
30
Waterproofing Membrane
0.00
7,074.00
0.00
7,074.00
?
-7,074.00
0.00
32
Flashpatching
33
Sika Ferroguard 903
0.001
2,072.00
.0
000
2,072.00
?
-2,072.00
0.00
34
Balcony walls and ceiling paint
1
000
3.500.00,
-3,500.00,
PAGE 2 TOTAL: 1 0.001 30.029.901 3,500.001 1 33,529.901 ?1 -33,529.901 0.001
GRAND TOTAL: 1 0.001 157,284.881 10,718.001 1 168,002.881 ?1 -168.002.881 0,001
A=Une Item Number B=Brief Item Description C=Total Value of Item D=Total of D and E From Previous Application(s) (If Any) E=Total Work Completed For This Application
F=Materials Purchased and Stored for Project G=Total of All Work Completed and Materials Stored for Project H=Remaining Balance of Amount to Finish I=Amount Withheld from G
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