HomeMy WebLinkAboutAPPLICATION AND CERTIFICATE FOR PAYMENTG702 APPLICATION and CERTIFICATE for PAYMENT
To: Beach Club Property Owners
Association, Inc.
9002 San Marco Court, Bldg 1000
From: Blue coast Construction
2587 SE Monroe st
Stuart, Florida 34997
Contract For: ConcRestoratlon,Palnting &
Project: Vistana Beach Club Concrete
Restoration, Painting and
Waterproofing Project
Application No: 4
App. Date: March 18, 2019
Period to: March 18, 2019
Project No:
Contract Date: August 10, 2018
Engineer Chalair and Associates
Distribution to:
[3 OWNER
E3 CONSTRUCTION MGR.
[3 ARCHITECT
[3 CONTRACTOR
0 ENGINEER
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 completed
in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and payments
1. ORIGINAL CONTRACT SUM 309,44 received from the Owner, and that current payment shown herein is now due.
2. Net Change By Change Orders 8,30:9.:4:7] CONTRACTOR:
3. CONTRACT SUM TO DATE 317,749.47 By: Date:
4. TOTAL COMPLETED AND STORED TO DATE 317,749,471
611111VAIMPF-Te1=11
a. of Completed Work
b. of Stored Material
TOTALRETAINAGE
6. TOTAL EARNED LESS RETAINAGE
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
0.00 presence and swore or affirnred to me that the contents of this document are truthful and
5:0:0:1 accurate to the best of his/her knowledge and belief.
317,� Notary Public: My Commission expires:
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ENGINEER'S CERTIFICATE FOR PAYMENT
8. CURRENT PAYMENT DUE 15,246271 in accordance with the Contract Documents, based on on�sile observations and the data
--- comprising this application, the Engineer certifies to the Owner that to the best of the
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0-001 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.
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in
previous months by Owner
0.00
0.00
Total approval this Month
8,309A7
0.00
TOTALS
8,309A7
0.00
NET CHANGES by Change Order
8,309.47
SCANNED
BY
St. Lucie County
AMOUNTCERTIFIED
(Attach explanation 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 original document which has this caution pdnted in red. An original assures that changes will not be obscured as may occur when documents are reproduced.
CXZ
CONTINUATION SHEET G703 PROJECT., Viistana Beach Club Concrete Restoration, Blue coast Construction
Page I of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Application No: 4
Contractor's signed Certification is attached. App. Date: March 18, 2019
Use Column I on Contracts where variable retainage for line items may apply. Period to: March 18, 2019
Project No:
A
B
C
D
I E
F
G
H
I
Item
#
Description of Work
Schedule
Of
Values
Work Completed
Materials
Stored & Used
Prior + Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previous
Application(s)
This
Period
1
Edge Epalls (d=6", w--9")
5,070.00
0.00
5,070.00
-5,070.00.
2
Partial Deck( alf slab)
169,125.00
160,500.00
0.00
160,500.00
94.90
8,625.00
0.00
3
Thru Deck
0.00
0.00
0.00
?
0.00
0.00
4
Ceiling Spells (half Slab)
5,415.00
5,415.00
0.00
5,415.00
100.00
0.00
0.00
5
Columns And Beams
600.00
1,400.00
0.00
1,400.00
233.33
-800.00
0.00
6
Concrete Railing Wall Repairs
0.00
601.97
0.00
601.97
?
-601.97
0.00
7
Concrete Rust Spots
3,000.00
3,000.00
0.00
3,000.00
100.00
0.00
0.00
8
Epoxy Gravity Feed (slab cracks)
16,000.00
0.00
0.00
0.00
16.000.00
0.00
9
Epoxy Joint Repairs Evazote
0.00
0.00
0.00
?
0.00
0.00
10
Stucco crack Repair
0.00
0.00
0.00
0.00
?
0.00
0.00,
11
SGD- R&R Deteriorated Caulking
0.00
0.00
0.00
0.00
?
0.00
0.00
12
Steel Column Partial Repair
0.00
0.00
0.00
?
0.00
0.00
13
Knee Wall Beam Spells (<Ix6"x6")
10,800.00
10,800.00
0.00
10,800.00
100.00
0.00
0.00
14
Knee Wall Removal
1,800.00
0.00
0.001
0.00
0.001
1,800.00
0.00
15
lKnee Wall Re -Construct
7,200.00
0.00
0.00
0.00
7,200.00
0.00
16
Window Removal and Re -install
3,000.00
0.00
0.00
0.00
3,000.00
0.00
17
Cementitious Coating Removal
19,300.00
19,300.00
0.00
19,300.00
100.00
0.00
18
Install Sika-Penetrating Corrosion Inhib.
19,300.00
19,300.00
0.00
19,300.00
100.00
0.00
19
Mobilization/ Demobilization / Permits
19,900.00
19,900.00
0.00
19,900.00
100.00
0.00
20
1
PAGE 1 TOTAL: 1 275.440.001 245,286.971 0.001 1 245,286.971 89.051 30,153.031 0.00
A=Llne 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=Matedals 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
TORGO SOFMARE �.TbmoSoft�e.wm 019W2013ALL RIG14TS RESERVED
CONTINUATION SHEET G703 PROJECT., Vistana Beach Club Concrete Restoration, Blue coast Construction
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing
Contractor's signed Certification is attached.
Use Column I on Contracts where variable retainage for line items may apply.
Application No: 4
Page 2 of 2
App. Date: March 18, 2019
Period to: March 18, 2019
Project No:
A
B
C
D
I E
F
G
H
I
Item
#
Description of Work
Schedule
Of
Values
Work Completed
Materials
Stored & Used
Prior + Current
Total Completed
and Stored
To Date
%
Balance
to Finish
Retainage
From Previo
Application( us
S)
This
Period
21
General Condition
22
Full Time Supervision
15,000.00
15,000.00
0.00
15,000.00
100.00,
0.00
0.00,
23
Pro ' lect Manager
5,000.00
5,000.00
0.00
5,000.00
100.00l
0.00
0.00
24
Daily Clean Up
5,000.00
5,000.00
0.00
5,000.00
100.001
0.00
0.00
25
Dumpsters / Pulls
5,000.00
5,000.00
0.00
5,000.00
100.001
0.00
0.00
26
Temporary Construction Fence
1,500.00
0.001
1,500.00
0.00
27
Temporary Toilet Facilities
1,500.00
1
0.00
1,500.00
0.00
28
Attic Stock
1,000.00
1,000.00
1,000.00
100.00
0.00
0.00
29
Watertight & Spraydeck 2,3,4 and 5
0.00
31,362.50
31,362.50
?
-31,362.50
0.00,
30
ISecond Floor Flooting
0.00
1,800.00
0.00
1,800.00
?
-1,800.00
0.00
31
IDoorTreshhold Repair
0.00
1,800.00
0.00
1,800.00
?
-1,800.00
0.00
32
IPeremeter Wall Repair and Paint
6,500.00
0.00
6,500.00
0.00
-6,501=
FAGE2TOTAL: 1 34,000.001 72,462.501 0.001 1 72,462.501 213.131 -38,462.501 0=-00
GRAND TOTAL: 1 309,440.001 317,749.471 0.001 1 317,749.471 102.691 -8,309.471 0.00
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=Matedals 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
TORGO SO�ARE �.T�goSoNmm.wm 0199&2013 ALL R1GKrS RESERVED