|
s
<br />-AIA Document G702 -1992
<br />Application and Certificate for Payment
<br />TO OWNER: City of South Bend PROJECT: South Bend Prairie Avenue APPLICATION NO: 9 Distribution to:
<br />PERIOD TO: 1/05/2023 OWNER ❑
<br />CONTRACT FOR: ARCHITECT ❑
<br />FROM CONTRACTOR: HRP Construction Inc. VIA ARCHITECT: HWC, Inc. CONTRACT DATE:
<br />12/14/2021 CONTRACTOR ❑
<br />PROJECT NOS: 117-068/ t FIELD ❑
<br />OTHER ❑
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />AIA Document G703®. Continuation Sheet, is attached.
<br />1.ORIGINAL CONTRACT SUM ................................................. $
<br />2. NET CHANGE BY CHANGE ORDERS ..............................
<br />3. CONTRACT SUM TO DATE (Line I f 2)..................................... $
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ......
<br />5. RETAINAGE:
<br />a. 5.0 % of Completed Work
<br />(Columns D + E on G703) $
<br />b. 5.0 % of Stored Material
<br />(Column F on G703) $
<br />Total Retainage (Lines Sa + 5b, or Total in Column I ofG703)...... $
<br />6. TOTAL EARNED LESS RETAINAGE.................................... $
<br />(Line 4 minus Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... $
<br />(Line 6 from prior Certificate)
<br />6. CURRENT PAYMENT DUE .....................
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 minus Line 6)
<br />1,671, 500.00
<br />35,527.02
<br />1,707,027.02
<br />1, 707, 027.02
<br />1,707,027.02
<br />1,621,675.67
<br />........................ I$ 85,351.35
<br />RANGE ORDER SUMMARY
<br />ADDITIONS
<br />DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />$
<br />$
<br />Total approved this month
<br />$ 35,527.02
<br />$
<br />TOTAL
<br />$ 35,527.02
<br />$
<br />ET CHANGES by Change Order 1
<br />$ 35,527.02
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, information
<br />and belief the Work covered by this Application for Payment has been completed in accordance
<br />with the Contract Documents, that all amounts have been paid by the Contractor for Work for
<br />which previous Certificates for Payment were issued and payments received from the Owner, and
<br />that current payment shown herein is now due.
<br />CONTRACTOR: HRP Construction Inc.
<br />By: k_ ��� Date: March 9, 2023
<br />State of: Indianaancy Knapik, Vicep
<br />. CYNTHIA L. VA:Expires
<br />HESTE
<br />County of: St. Joseph a�x. ..... *d9 � Notary Public, statef Indiana
<br />Subscribed and sworn to before Z: SEAL;"= St. Joseph Conty
<br />me this day of rt , * Commission Numb681273
<br />9th y March, 2023 -; , ...• p My Commission March 06, 224
<br />Notary Public:
<br />My commission expires: 03/06/2024 Cynthia L. Vanheste
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />In accordance with the Contract Documents, based on on -site observations and the data comprising
<br />this application, the Architect certifies to the Owner that to the best of the Architect's knowledge,
<br />information and belief the Work has progressed as indicated, the quality of the Work is in
<br />accordance with the Contract Documents, and the Contractor is entitled to payment of the
<br />AMOUNT CERTIFIED.
<br />AMOUNTCERTIFIED............................................................................. $
<br />(Attach explanation if amount certified differs from the amount applied. Initial all figures on this
<br />Application and on the Continuation Sheet that are changed to conform with the amount certified.)
<br />ARCHITECT:
<br />By:
<br />Date:
<br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
<br />named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
<br />the Owner or Contractor under this Contract.
<br />AIA Document G7020 —1992. Copyright 0 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. The "American Institute of Architects," "AIA," the AIA Logo, "G702," and
<br />"AIA Contract Documents" are registered trademarks and may not be used without permission. To report copyright violations of AIA Contract Documents, e-mail copyright@aia.org.
<br />
|