HomeMy WebLinkAboutAPPLICATION AND CERTIFICATION FOR PAYMENTSC N/VED
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G702 APPLICATION and CERTIFICATE for PAYMENT ry
To: Agents III By The Sea
Project Atlantis III by the Sea Application No: 1
Distribution to:
10200S Ocean Drive
Condominium Association App. Date: June 25, 2018
❑ OWNER
Jensen Beach, Florida
❑ CONSTRUCTION MGR.
From: Blue mast Cons
Construction
Period to:
❑ ARCHITECT
2587 SE Mon e t
roa
Project No:
❑CONTRACTOR
®ENGINEER
Stuart, Florida 34997
Contract Date:
Contract For. Concrete Restoration Engineer. Matters Engineering
APPLICATION FOR PAYMENT The undersigned Contractor certifies mat to the best of the Contmcmrs knowledge,
Application is made for payment, as shown below, In connection with the Contract information and belief me Work covered by this Application for Payment has been completed
I. accordance with the Contract Documents, that all amounts have been paid by the
Continuation Shee[, G703, is attached. Contractor for Worl for which prevlous Certificates for Payment were Issued and payments
1. ORIGINAL CONTRACT SUM a 00 received from the Owner, and that current payment shown herein is now due.
2. Net Change By Change Orders 113,116.78 CONTRACTOR:
3. CONTRACT SUM TO DATE 113,116.78 By: Date:
4. TOTAL COMPLETED AND STORED TO DATE 115,300.78
S. RETAINAGE:
a. of Completed Work 10,786.27
Is. of Stored Material 0.00
TOTAL RETAINAGE 10,78627
6. TOTAL EARNED LESS RETAINAGE 104,514.51
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
8. CURRENT PAYMENT DUE 104,574.51
9. BALANCE TO FINISH, INCLUDING RETAINAGE 8,602.27
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous Months by Owner
0.00
0.00
Total approval this Month
113.116.78
0.00
TOTALS
113,116.78
0.00
NET CHANGES by Change Order
113,116.78
State of
County of
Subscribed and swom before me this day of
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 doaanenl are truthful and
aaarete to the best of hWher knowledge and belief.
Notary Public: My Commission expires:
ENGINEER'S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on-ske observations and the data
comprising tits applicallon, the Engineer certifies to the Owner that to the best of the
Engineers 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
entiged to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED
(Amatlt explanallon if amount certified differs from the amount applied for. Initial all figures
on this Application and on the Continuation Sheet that are changed to conform to the
amount certified.)
ENGINEER
By:
Date:
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
CAUTION: You should use an onginal 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 whieh has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced.