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A <br /> � � �r/ t <br /> • \ <br /> APPLICATION AND CERTIFICATE FOR PAYMENT AlA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF 2 PA�,ES <br /> TO (OWNER): Clty' Of Decatur PROJECT: NelsOn Park Boat APPLICATION NO: 2 Distribution to:• <br /> ❑ OWNER <br /> Dock Repairs ' pRiQ DzQ ❑ ARCHITECT <br /> 1�-1—�f�S� t0 1-16-89 ❑ CONTRACTOR <br /> FROM (CONTRACTOR): VIA (ARCHITECT): �, ARCHITECT'S O <br /> PROJECT NO: 8828 ❑ <br /> Thrifty Supply Blank� Wesselink Cook & ;Assoc . <br /> CONTRACT FOR: � CONTRACT DATE: <br /> CONTRACTOR'S APPLICAT�ON FOR PAYMENT Continu ton Sheet,fAlA Do ument G703nibatt chedconnection with the Contract. <br /> � CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM ....................... $ 10.53�.00 <br /> Change Orders approved in ADDITIONS DEDUCTIONS 2• Net change by Change Orders ........ .. ..... .. .... $ �.�89.00 <br /> previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 ±2) ......... .... . $ 1�,6z3.0� <br /> TOTAL 4. TOTAL COMPLETED & STORED TO DATE............ $ �-4'.623.00 <br /> Approved this Month (Column G on G703) , <br /> 5. RETAINAGE: <br /> Number Date Approved � - a. � % of'Corfipleted Work $ <br /> ���� (Column D+E on G703) <br /> 1 11�29 � ��089.0 � ��" b. � % of Stored Material $ <br /> � �� (Column F on G703) <br /> %/� �f�g� Total Retainage (Line Sa+Sb or <br /> TOTALS s pp��,- 4 (p3 Total in Column I of G703) ........ ......... $ 0 <br /> Net chan e b Chan e Orders 6. TOTAL EARNED LESS RETAINAGE ................... $ �-'4'r 62 3.00 <br /> The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line 5 Total) <br /> information and belief the Work covered by this Application for Payment has been �• LESS PREVIOUS CER"fIFICATES FOR <br /> completed in accordance with the Contract Documents, that all amounts have been PAYMENT (Line 6 frorri prior Certificate)......... $ 9 e 20�.00 <br /> paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE .... ...................... $ ���'19.00 <br /> � issued and payments received from the Owner, and that current payment shown 9. BALANCE TO FINISH, PLUS RETAINAGE ............. $ � <br /> herein is now due. <br /> (Line 3 less Line 6) <br /> CONTRACTOR: ThY'].f't31 Supply State of: � � C nty of: v <br /> Subscribed and swom o before me t ' /� day of��� ,19�� <br /> � . <br /> � Notary Public: � <br /> By: G�"`��� L � �r Date: 1—��'-89 My Commission ex ires: <br /> a.r'O epzi AMOUNT CERTIFIED.... ......�Iy.�qO� <br /> ARCHITECT'S CERTIFICATE FOR PAYMENT ���� <br /> (Attach explanation if am �pplied for.) <br /> In accordance with the Contract Documents, based on on-site observations and the ` ARCHiTECT: ANK L+I SEL Pd C00 & SOCIATES , INC. <br /> data comprising the above application,the Architect certifies to the Owner that to the v <br /> best of the ArchitecYs knowledge,information and belief the Work has progressed as gY: 1� . p���; Z/2O/H9 <br /> , indicated,the quality of the Work is in accordance with the Contract Documents,and This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br /> the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractor named herein. Issuance,payment and acceptance of payment are without <br /> prejudice to any rights of the Owner or Contractor under this Contract. <br /> AIA DOCUMENT G702•APPLICATION AND CERTIFICATE FOR PAYMENT•MAY 1983 EDITION•AIA" •�� 1983 . <br /> � THE AMERICAN INSTITUTE Of ARCHITECTS, �735 NEW Y'ORK nVENUE, N.W., WASHINGTON, D.C. 20006 G7O2-1983 <br />