HomeMy WebLinkAboutAPPLICATION AND CERTIFICATION FOR PAYMENTI PAGE OF 1 PAGES
APPLICATION AND CERTIFICATION FOR PAYMENT
TO CONTRACTOR: IIIt2WOCPf�
1000 Market Street, Suite 300
Portsmouth, New Hampshire 03801
FROM SUBCONTRACTOR:
RTI Restoration Technology, Inc.
8930 W State Road 84 Suite 4319
Davie, FL 33324
PROJECT: Balcony Restoration
Courtyard Marriott Jensen Beach
ENGINEER:
McCarthy and Associates
2555 Nursery Road, Suite 101
Clearwater, F133764-3080
AIA DOCUMENT G702
PERIOD TO: 10/15/2019
PROJECT NOS: N/A
EXHIBIT'IF"
V5-ft Distribution to:
=OWNER
=ENGINEER
F—ICONTRACTOR
0
0
(7 ACT FOR.
CONTRACT DATE: November 1, 2018
'TRACTOR'S APPLICATION FOR PAYMENT
The undersigned Contractor certifies that to 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
Continuation Sheet, AIA Document G703, is attached,
' r�
completed in accordance with the Contract Documents, that all amounts have been paid by v
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.., /L
1. ORIGINAL CONTRACT SUM
2. Net change by Change Orders
3. CONTRACT SUM TO DATE (Line 1 3 2)
p-TOTSO,-U PlZ]7ED:&-STORED:TOI�S;!.
DATE (Column G on G703)
5. RETAINAGE:
a. 10 % of Completed Work
(Column D +E on G703)
b. % of Stored Material
(Column F on G703)
Total Retainage (Lines 5a+5b or
Total in Column I of G703)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 Less Line 5 Total)
PREVIOUS CERTIFICATES FOR
I'v1ENT (Line 6 from prior Certificate)+$3,547.09 for pemtit fee
3. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE $
(Line 3 less Line 6)
$ 162,434.50
$ 3547.09
CONTRACTOR:
165,981.59
��
. - _ ...
BY: o GYi%�
�j I
Date:
I!%• 9' � ./
0.00
State of FLORIDA o
Subscribed and swom to b
Ir",thia,,
ay ofbG3EFF•WQVININEPOL
Notary Public:
oK� e; `z ,
minty Public - S;iyte of Florida
My Commission eiryires:
�,• • ,y{OQqlim�is;Ion # FF 966869
VGo41d✓EuRIL in 25, 2020
$ - 0.00.
3 161.083.60
$ 143,611.82
+-11T,4ZI78ii
0.00
CHANGE ORDER SUMMARY -
ADDITIONS
DEDUCTIONS
Total changes approved
in preview months by Owner
$3,547.09
$0.00
Total approved this Month
TOTALS
$3,547.09
$0.00
NET CHANGES by Change Order
$3,547.09
In accordance with the Cm&.ci Doc ts, &Aed on on -site observations and the data 'I
comprising the applicatron, the ENG PER certifies to the Owner that to the best of the
ENGINEER's knowledge, informati and belief the Work has progressed as indicated,
the quality of the Work is in accordance with the Contract Documents, and the Contractor
is entitled to payment of the AMOUNT CERTIFIED.
�+
A�40�•Ut3T ERT�iF ...........$ 17,471.78
(Attach explanation ifamount certified d fersfrom the amount applied Initial all figures on this
Application and onthe Continuation Sheet that are changed to conform with 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.
AIADOCUMENTG702 APPLICATION AND CERTIFICATION FOR PAYMENT 1MEDITION NA M94 THEFMERICMINSTIU OFENGINEFA5.1735NEWWRKAM.N.W..WPSHINGTON,OC200 52n
Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee.
i
CONTINUATION SHEET AIA DOCUMENT G 703
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 5
Contractors signed ceni cation is attached.
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10115/19
Use Column 1 on Contmcls where variable retamage for line hems may apply. ARCHITECTS PROJECT NO: WA
B
C
D
E
F
G
H
1
DESCRWTXr NOF WORK
scTIEDUIED
WORKCOMPLETED
MATEEUuLa
Y.
BALANCE
RETA AGE
VALUE
FROMPREVIOUS
THIS PERIOD
PRESENTLY
MPLET
(G-C)
TOFINLSH
(IF VARIABLE
APPLICATION
STORED
YORE
(C-G)
RATE)
(D+E)
(NOTM
-
DORE)
0>+E+
Mobilization, demobilization & cleanup
$14,500.00
- S14,500.00
$14,500.00
100.00%
$0.00
General conditions & supervision
$27,372.00
$27,372.00
$27,372.00
100.00%
$0.00
Edge repairs (up to 8" back)
$26,279.80
S24,490.50
$1,789.30
$26,279.80
100.00%
$0.00
Full depth slab repairs
$4,492.50
$3,842.50
$650.00
$4,492.50
100.00%
$0.00
Column repairs
$623.00
$623.00
$623.00
100.00%
$0.00
Stucco
$7,597.40
$7,597.40
$7,597.40
100.00%
$0.00
Tile removal (surface preparation)
$1,389.45
$1,389.45
$1,389.45
100.00%
$0.00
Railing removal and reinstallation of existing
$3,950.39
$1,819.00
$195.00
$2,014.00
50.98%
$1,936.39
Installation of shoring t&m
$2,500.00
$1,400.00
$1,400.00
56.00%
$1,100.00
Swingstage rental
$9,600.00
$9,600.00
$9,600.00
100.00%
$0.00
Swingstage erection, relocation&dismantling
$17,500.00
$17,500.00
$17,500.00
100.00%
$0.00
Painting of repaired areas
$2,275.00
$413.40
$413.40
18.17%
$1,861.60
Waterproofing
$0.00
CHANGE ORDER:
I
Permit Fee
$3,547.09
$3,547.09
$3,547.09
100.00%
$0.00
2
Anodes, Dowels and Reinforcing
$7,851.32
$7,851.32
$7,851.32
100.00%
$0.00
3
Flashing Patching, slab repairs
$8,652.60
$8,652.60
$8,652.60
100.00%
$0.00
4
Shoring Rental
$611.51
$611.51
$611.51
100.00%
$0.00
4
Partial depth slab repairs
$3,420.95
$3,420.95
$3,420.95
100.00%
$0.00
4
Stucco Repairs
$1,818.60
$1,818.60
$1,818.60
100.00%
$0.00
4
Swingstateg Erection/Relocation
$1,800.00
$1,800.00
$1,800.00
100.00%
$0.00
4
Anodes, Dowels and Reinforcing
$5,362.50
$5,362.50
$5,362.50
100.00%
$0.00
5
Waterproofing,Anodes, Flash patching, Stucco, Swingstage,
$14,837.48
$14,837.48
$14,837.48
100.00%
$0.00
GRAND TOTALS
1 $165,981.591
$143,611.82
$17,471.78
$0.00
16RM'::: (01,1
1 $0.00
1 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document 0401-Cem0cation of Document's Authenticity
M4C0WU O7W-COm"PONSHEETFORW(Q'1Mffl=N P VM
THE PIAERICM WSn OF MCHI Om, 1735 NEW YOM AVE NW. WMM OTON. 0
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