746x Filetype XLS File size 0.13 MB Source: kroggrp.com
Sheet 1: G702
APPLICATION AND CERTIFICATE FOR PAYMENT | AIA DOCUMENT G 702 | ||||||||||||||
To (Owner) | Project | Application Number | |||||||||||||
Application Date | [ ] OWNER | ||||||||||||||
[ ] ARCHITECT | |||||||||||||||
From | The Krog Group | Period From: | [ ] CONTRACTOR | ||||||||||||
4 Centre Drive | Job # | To: | |||||||||||||
Orchard Park, New York 14127 | |||||||||||||||
Contract For: | CONTRACT DATE: | ||||||||||||||
Contractors Application for Payment | Application is made for Payment, as shown below, in connection with the | ||||||||||||||
Change Order Summary | Contract. Continuation Sheet, AIA Document G703, is attached. | ||||||||||||||
Change Orders approved in | |||||||||||||||
previous months by Owner | - | 1. ORIGINAL CONTRACT AMOUNT | - | ||||||||||||
TOTAL | Additions | Deductions | 2. Net Change by Change Orders | $ | - | ||||||||||
Approved this Month | 3. CONTRACT SUM TO DATE | - | |||||||||||||
(Line 1 + or -2) | |||||||||||||||
Number | Date Approved | 4. TOTAL COMPLETED & STORED TO DATE | - | ||||||||||||
- | (Column G on G703) | ||||||||||||||
5. RETAINAGE (10% of Contract Completion) | - | ||||||||||||||
(Column I on G703) | |||||||||||||||
TOTALS | 6. TOTAL EARNED LESS RETAINAGE | - | |||||||||||||
Net Change by change Orders | - | (Line 4 less Line 5) | |||||||||||||
The undersigned Contractor certifies that to the best of the Contractor's | 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT | ||||||||||||||
knowledge, information and belief the Work covered by this application | (Line 6 from prior Certificate) | ||||||||||||||
for Payment has been completed in accordance with the Contract | |||||||||||||||
Documents, that all amounts have been paid by the Contractor for Work | 8. CURRENT PAYMENT DUE | - | |||||||||||||
for which previous Certificates for Payment were issued and payments | |||||||||||||||
received from the Owner, and that current payment shown herein is now due. | |||||||||||||||
9. BALANCE TO FINISH, PLUS RETAINAGE | - | ||||||||||||||
CONTRACTOR: The Krog Group | (Line 3 less Line 6) | ||||||||||||||
By:________________________________________ Date: | State of New York County of Erie | ||||||||||||||
Project Manager | Subscribed and sworn to before me this day of , 20 | ||||||||||||||
Notary Public: | |||||||||||||||
My commission expires: | |||||||||||||||
ARCHITECT'S CERTIFICATE FOR PAYMENT | AMOUNT | CERTIFIED | $ | ||||||||||||
In accordance with the Contract Documents, based on on-site observations | Attach explanation is amount certified differs from the amount applied for. | ||||||||||||||
and the data comprising the above application, the Architect certifies to the | ARCHITECT: | ||||||||||||||
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 | By: | Date: | |||||||||||||
the Contractor Documents, and the Contractor is entitled to payment for the | |||||||||||||||
AMOUNT CERTIFIED. | 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 the Contract. |
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