HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENT•'G732fCM'aOYformerly G7021GfWa)TF- {-APPLIGATION and CERTIFICATE for PAYMENT
To: Islagnd Crest Condominium Project: Island Crest Concrete restoration Application No: 3 Distribution to:
10680 South Ocean Blvd. App. Date: January 13, 2018 ® OWNER
Jensen Beach, FL 31957 Period to: D CONTRACTOR
CONSTRUCTION MGR.
From: Blue coast Construction FILE U ff
2587 SE Monroe St Project No:OTHER
Stuart, Florida 34997 Contract Date:
Contract For: Concrete Restoration Construction Manager. CSM Engineering, LLC Architect:
APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors 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
in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, 3703, Is attached. Contractor for Work for which previous Certificates for Payment were issued and payments
1. ORIGINAL CONTRACT SUM SCANNED 201.87--- received from the Owner, and that current payment shown herein is now due.
2. Net Change By Change Orders BY 116,709,42 CONTRACTOR:
`- 3. CONTRACT SUM TO DATE St. Lucie County 318,586.42 By; Date:
4. TOTAL COMPLETED AND STORED TO DATE 318,586.42
5. RETAINAGE:
a. of Completed Work
b. of Stored Material
TOTAL RETAINAGE
6. TOTAL EARNED LESS RETAINAGE
State of.
County of:
29,920.64
Subscribed and sworn before me this day of
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
29,920.64
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.
288,665.78
Notary Public: My Commission expires:
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 215,347.11 CERTIFICATE FOR PAYMENT
8. CURRENT PAYMENT DUE 73,318.67 In accordance with the Contract Documents, based on on -site observations and the data
9: BALANCE TO FINISH, INCLUDING RETAINAGE 29,920.64 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.
,[CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
36,015.68
0.00
Total approval this Month
80.693.74
0.00
TOTALS
116.709.42
0.00
NET CHANGES by Change Order
1.16,709.42— —1
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CONSTRUCTION MANAGER:
By: Date:
ARCHITECT:
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 original document whictiAas tFpEcauriorrpr`1 m rd'" e-U. Nn' original assures that changes will not be obscured as may occur when documents are reproduced.
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CONTINUATION SHEET G703 PROJECT: Island Crest Concrete restoration Blue coast Construction Page 1 of 1
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Application No: 3
Contractor's signed Certification is attached. App. Date: January 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 Com leted
Materials
Stored & Used
Prior + Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Period
0
Permit
2.392.02
0.00
2,392.02
-2,392.02
1
Mobolization
5,000.00
5,000.00
0.00
5,000.00
100.00
0.00
0.00
2
Demobilization
3,000.00
0.00
3,000.00
3,000.00
100.00
0.00
0.00
3
Partial Deck Repair
15,572.00
16,028.96
702.44
16,731.40
107.45
-1,159.40
1,673.14
4
Concrete Column Repair
2,500.00
500.00
2,895.00
3,395.00
135.80
-895.00
339.50
5
Concrete Deck Slab Repair (Full Depth)
35,600.00
115,621.60
33,085.60
148,707.20
417.72
-113,107.20
14,870.72
6
Concrete Deck Slab Repair (Overhead)
37,400.00
0.00
0.00
0.00
0.00
37,400.00
0.00
7
Edge Repair
25,630.00
63.141.101
12,448.70
75,589.80
294.93
-49,959.80
7,558.98
8
Removal of Tile
5.760.00
1,860.00
0.00
1,860.00
32.29
3,900.00
186.00
9
Waterproofing
13,500.00
0.00
0.00
0.00
0.00
13,500.00
0.00
10
Additional exterior paint
11
Zinc Anodes
11,000.00
6,274.00
1,034.00
7,308.00
66.44
3,692.00
730.80
12
Stucco Repair
9,000.00
0.00
0.00
0.00
0.00
9,000.00
0.00
14
Wheather Wall installation & Removal
13,760.00
9,800.00
3,600.00
13,400.00
97.38
360.00
1,340.00
17
Remove, store, & reinstall Glass Doors
13.805.00
5,005.00
1.595.00
6,600.00
47.81
7,205.00
660.00
18
Remove, store & reinstall Railing
3,600.00
8,325.00
11,835.00
20,160.00
560.00
-16,560.00
2,016.00
20
Fill Post Holes post
6,750.00
0.00
0.00
0.00
0.00
6,750.00
0.00
21
Hook Bars For Rail post
0.00
4,055.00
1,400.00
5,455.00
?
-:I', no 00
545.50
22
Steel Column Installation
1,300.00
1,300.00
-1,300.00
23
Balcony Paint
6,500.00
6,500.00
-6.500.00
24
Waterproofing Balcony edges
1,188.001
1 1,18B.00
-1,188.00
GRAND TOTAL: 1 201,877.001 238,002.681 80,583.741 1 318,586.42 157.81-116,709.42 29,920,64
A=Line 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 1=Amount Withheld from G
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