Filetype Excel XLS | Posted on 08 Aug 2022 | 3 years ago
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207x Filetype XLS File size 0.07 MB Source: www.hpsmechanical.com
Sheet 1: Application & Cert
| APPLICATION AND CERTIFICATE FOR PAYMENT | CONSTRUCTION MANAGER-ADVISOR EDITION | |||||||||||||||
| AIA DOCUMENT G702/Cma | PAGE 1 OF 2 PAGES | |||||||||||||||
| CONTRACTOR: | HPS Mechanical, Inc. | PROJECT: | APPLICATION NUMBER: | Distribution to: | ||||||||||||
| 3100 E. Belle Terrace | PERIOD TO: | OWNER | ||||||||||||||
| Bakersfield, CA 93307 | PROJECT NOS.: | CONSTRUCTION | ||||||||||||||
| MANAGER | ||||||||||||||||
| SUBCONTRACTOR: | CONTRACT DATE: | ARCHITECT | ||||||||||||||
| X | CONTRACTOR | |||||||||||||||
| VIA CONSTRUCTION MANAGER: | ||||||||||||||||
| CONTRACT FOR: | VIA ARCHITECT: | |||||||||||||||
| CONTRACTOR'S APPLICATION FOR PAYMENT | The undersigned Contractor certifies that to the best of the Contractor's knowledge, | |||||||||||||||
| Application is made for payment, as shown below, in accordance with the Contract. | information and belief, the Work covered by this Application for Payment has been | |||||||||||||||
| Continuation Sheet, AIA Document G703, is attached. | completed in accordance with the Contract Documents, that all amounts have been | |||||||||||||||
| 1. | ORIGINAL CONTRACT SUM | 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. | ||||||||||||||||
| 2. | Net Change By Change Orders………………………. | $0.00 | CONTRACTOR: | |||||||||||||
| 3. | CONTRACT SUM TO DATE | (Line 1 +2)…… | $- | A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, | ||||||||||||
| and not the truthfulness, accuracy, or validity of that document. | ||||||||||||||||
| 4. | TOTAL COMPLETED & STORED TO DATE………….. | $0.00 | ||||||||||||||
| (Column G on G703) | By: ____________________________________________________________ | Date: | 05/04/15 | |||||||||||||
| State of: California | County of: | Kern | ||||||||||||||
| 5. | RETAINAGE: | Subscribed and sworn before me on this | 08th day of August, 2022 | by: | proved to me | |||||||||||
| a. | 5% | % of Completed Work | $0.00 | on the basis of satisfactory evidence to be the person who appeared before me. | ||||||||||||
| (Columns D & E on G703) | ||||||||||||||||
| b. | 0% | % of Stored Material | $0.00 | Notary: | My Commissioning Expires: | |||||||||||
| (Column F on G703) | ||||||||||||||||
| Total Retainage (Line 5a + 5b or | CERTIFICATE FOR PAYMENT | |||||||||||||||
| Total in Column 1 of G703) | $0.00 | |||||||||||||||
| In accordance with the Contract Documents, based on on-site observations | ||||||||||||||||
| 6. | TOTAL EARNED LESS RETAINAGE…………………… | $0.00 | and the data comprising the above application, the Construction Manager | |||||||||||||
| (Line 4 less Line 5 Total) | certifies that to the best of his knowledge, information and belief the Work | |||||||||||||||
| has progressed as indicated, the quality of the Work is in accordance with | ||||||||||||||||
| 7. | LESS PREVIOUS CERTIFICATES FOR PAYMENT | the Contract Documents, and the Contractor is entitled to payment of the | ||||||||||||||
| (Line 6 from prior Certificate) | $0.00 | AMOUNT CERTIFIED. | ||||||||||||||
| 8. | CURRENT PAYMENT DUE | $0.00 | AMOUNT CERTIFIED……………………. | $- | ||||||||||||
| (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this | ||||||||||||||||
| 9. | BALANCE TO FINISH, INCLUDING RETAINAGE | Application and on the Continuation Sheet that changed to conform to the amount certified.). | ||||||||||||||
| (Line 3 less Line 6) | $- | CONSTRUCTION MGR: | ||||||||||||||
| By:___________________________________________Date:__________________ | ||||||||||||||||
| CHANGE ORDER SUMMARY | ADDITIONS | DEDUCTIONS | ||||||||||||||
| Total changes approved in | ARCHITECT: | |||||||||||||||
| previous months by Owner | By:____________________________________________ Date: _________________ | |||||||||||||||
| Total Approved this Month | This certificate is not negotiable. The AMOUNT CERTIFIED is payable only | |||||||||||||||
| TOTALS | $0.00 | $0.00 | to the Contractor named herein. Issuance, payment and acceptance of | |||||||||||||
| NET CHANGES by Change Order | $0.00 | payment are without prejudice to any rights of the Owner or Contractor under | ||||||||||||||
| this Contract. | ||||||||||||||||
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