CONTRACTOR'S APPLICATION FOR PAYMENT - NNI Construction

APPLICATION AND CERTIFICATION FOR PAYMENT

TO OWNER:

PROJECT:

FROM CONTRACTOR:

VIA ARCHITECT:

CONTRACTStellar surfaces

CONTRACTOR'S APPLICATION FOR PAYMENT

Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached.

1. ORIGINAL CONTRACT SUM

$

2. Net change by Change Orders

$

3. CONTRACT SUM TO DATE (Line 1 ? 2)

$

4. TOTAL COMPLETED & STORED TO

$

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)

7. LESS PREVIOUS CERTIFICATES FOR

PAYMENT (Line 6 from prior Certificate)

$

8. CURRENT PAYMENT DUE

$

9. BALANCE TO FINISH, INCLUDING RETAINAGE

$

(Line 3 less Line 6)

CHANGE ORDER SUMMARY Total changes approved in previous months by Owner Total approved this Month

TOTALS

ADDITIONS

DEDUCTIONS

NET CHANGES by Change Order

AIA DOCUMENT G702

APPLICATION NO:

PERIOD TO:

PAGE ONE OF

PAGES

Distribution to:

OWNER

ARCHITECT

CONTRACTOR

PROJECT NO'S: COMMITMENT NO'S CONTRACT DATE:

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.

CONTRACTOR:

By:

State of: Subscribed and sworn to before me this Notary Public: My Commission expires:

Date:

County of: day of

ARCHITECT'S CERTIFICATE FOR PAYMENT

In accordance with the Contract Documents, based on on-site observations and the data comprising the 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 certified differs from the amount applied. Initial all figures on this

Application and onthe Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT:

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.

CONTINUATION SHEET

AIA DOCUMENT G703

A ITEM NO.

B DESCRIPTION OF WORK

C SCHEDULED

VALUE

D

E

WORK COMPLETED

FROM PREVIOUS

THIS PERIOD

APPLICATION

(D + E)

F MATERIALS PRESENTLY

STORED (NOT IN D OR E)

PAGE OF PAGES

APPLICATION NO: APPLICATION DATE:

PERIOD TO: NNI's PROJECT NO:

G TOTAL COMPLETED AND STORED TO DATE (D+E+F)

H % (G ? C)

I BALANCE TO FINISH

(C - G)

J RETAINAGE (IF VARIABLE

RATE)

GRAND TOTALS

CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT

To All Whom It May Concern:

The undersigned is to be paid a final payment in the sum of $

(Amount)

for labor, services, equipment, or material furnished

.

Upon receipt and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this

document shall become effective to release any mechanic's lien, stop notice or bond right the undersigned has on the job

of:

Job Name:

Address:

City:

County:

State:

This release covers the final payment to the undersigned for all labor, services, equipment, or material furnished on the job,

except for disputed claims for additional work in the amount of $

. Before any recipient of this document

relies on it, the party should verify evidence of payment to the undersigned

By: _____________________________ Print Name: Print Title:

Company Name: Company Trade: Dated:

SWORN TO BEFORE ME AND SUBSCRIBED IN MY PRESENCE,

at

, this

day of

A. D., 20

Wavier of Lien 2016

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download