HomeMy WebLinkAboutAPPLICATION AND CERTIFICATION FOR PAYMENTSCANNED
BY
St. Lucie County
G702 APPLICATION and CERTIFICATE for PAYMENT
To: Atlantis III By The Sea
PrcJect: ABantis III by the Sea
Application No: i
Distribution to:
10200 S Ocean Drive
Condominium Association
App, Date: June 25, 2018
❑ OWNER
Jensen Beach, Florida
❑ CONSTRUCTION MGR.
Front: Blue toast Construction
Periodic:
Periodic:
❑ ARCHITECT
CONTRACTOR
2567 BE Monroe st
Project No:
®ENGINEER
Stuart, Florida 34997
Contract Data:
Contract Far. Concrete Restoration
Engineer. Mothers Engineering
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
Continuation Shoat, G703, is attached.
In accordance with the Contract Documents, net all amounts have been paid by the
Contractor for Wodofor which previous Certificates for Payment were Issued and payments
1. ORIGINAL CONTRACT SUM 0.00
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
5. RETAINAGE:
a. of Completed Work 10,786.27
b. of Stored Material 0.00
TOTAL RETAINAGE 10,786.27
6. TOTAL EARNED LESS RETAINAGE 104.514.51
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
8. CURRENT PAYMENT DUE 104,514.51
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 Ord.,
113.116.78
State of:
County of:
Subscribed and sworn 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 document are truthful and
accumte to the bear of his/her knowledge and bellef.
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 cerTes to the Owner that to the best of the
Enginaels 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 confined differs from the amount applied for. Initial all figures
on this Application and on the Continuation Sheet that are changed to write= 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 Conbect.
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 oceurwhen documents are reproduced.
'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.