PCA - Century Center Skyway Restroom Upgrade Proj No. 123-042 - Larson-Danielson

Home Browse Search

LARSON-DANIELSON CONST CO. INC. LARSON-DANIELSON CONST CO. INC. 302 Tyler Street LaPorte, IN 46350 Application and Certificate for Payment SB,CTYOF-CC NRTH R/R RENO 56668 6/27/2023 56668-00004 AMERICAN STRUCTUREPOINT 7260 SHADELAND STATION INDIANAPOLIS, IN 46256 120 DR MLK JR BLVD SOUTH BEND, IN 46601 2/29/2024 Century Center Skyway N. Restroom Reno X227 W. JEFFERSON ST. SOUTH BEND, IN 46601 SOUTH BEND, CITY OFTO OWNER: FROM CONTRACTOR:VIA ARCHITECT: PROJECT:APPLICATION NO: PERIOD TO: CONTRACT FOR: CONTRACT DATE: CONTRACT NO: OWNER ARCHITECT CONTRACTOR FIELD OTHER Distribution to: $ 171,056.00 $ 4,010.00 $ 167,046.00 $ 171,056.00 $ 0.00 $ 0.00 $ 0.00 $ 171,056.00 $ 162,064.29 $ 8,991.71 $ 0.00 0.00 AMERICAN STRUCTUREPOINT 0.00 INDIANA LAPORTE 4,010.00 4,010.00 462.00 3,548.00 1. ORIGINAL CONTRACT SUM............................................. 2. NET CHANGE BY CHANGE ORDERS............................... 3. CONTRACT SUM TO DATE (Line 1 +/- 2)........................... 4. TOTAL COMPLETED & STORED TO DATE..................... 5. RETAINAGE: CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Schedule of Values is attached. The undersigned Contractor certifies that to the best of the Contractor's knowledge, 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 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. % of Completed Work (Columns D + E on SOV) % of Stored Material (Column F on SOV) Total Retainage (Lines 5a + 5b, or Total in Column 1 of SOV) a. b. 6. TOTAL EARNED LESS RETAINAGE................................. (Line 4 minus Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT.......... (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE............................................... 9. BALANCE TO FINISH, INCLUDING RETAINAGE.......... (Line 3 minus Line 6) NET CHANGES by Change Order TOTAL Total approved this Month Total changes approved in previous months by Owner CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONTRACTOR: By: ________________________________Date: __________________ ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising this application, the Architect certifies to the Owner that to the best of the Architect'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. AMOUNT CERTIFIED............................................................ (Attach explanation if amount applied. Initial all figures on this Application and on the Schedule of Values that are changed to conform with the amount certified.) ARCHITECT: 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. By: ________________________________Date: __________________ State of: County of: Subscribed and sworn to before me this day of Notary Public: My commission expires: $ (Column G on SOV)