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<br />Document G703Tilr -1992
<br />Continuation Sheet
<br />AIA Document 13702T"L1M, 4ppli!lation and Certificate for Payment, 6r 0132Tm-2009, APPLICATlC*10/22/2021
<br />Application and CertifiQatclor Payment, Construction Manager as Adviser Edition, ApAi{ A .DATE' IO/222021
<br />containing ContraQWT's*gned certification' is attached.
<br />In tabulations -below, amounts are in US dollars. PZPJOD TO. 6484
<br />Use C611 lti Contracts where variable retainage for line items may apply. 1KRCFflTECT'S PROJECT NO:
<br />A-r B C D E P (i H
<br />F
<br />WORK COMPLETED
<br />MATERIALS TOTAI.
<br />i
<br />ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLEI'EDAND % B ANCETO RETAINAGE
<br />NO. VALUE FROM PREVIOUS ,FINISH
<br />APPLICATION THIS PERIOD STORED STORED TO DATE (G = C) FC _ G} (If variable rate)
<br />(D +E) (Not in D or E) (D+E+F)
<br />i
<br />02
<br />Rond, Insurance, Mobilize
<br />10,200.00 10,200.00
<br />03
<br />caeneral Conditions
<br />27,100.00 10,306.13
<br />3,368.53
<br />04
<br />4119 Demolition
<br />.17,000.00 15,300.00
<br />33000 Concrete
<br />12,000.00
<br />8,040.00
<br />06
<br />.55000 Metal Fabricati6n's
<br />8,000.00
<br />07
<br />61000 Rough,.Carpentry
<br />7,200.00 5,760.00
<br />08
<br />652013 Exterier itihlsh Carp
<br />7,800.00 1
<br />3,900.00
<br />09
<br />3313 PzvmDoors
<br />300.00
<br />150.00
<br />10 :.
<br />3-1--S--Coiling Doors
<br />5,300.00
<br />11 '
<br />t200() Gypsum Board
<br />12,000.00
<br />12
<br />3000Tile
<br />7,500.00
<br />13
<br />500 Rubber Floor
<br />4,500.00
<br />14
<br />M7750 FRP
<br />6,000.00
<br />15
<br />D99100 Painting
<br />5,500'00
<br />16
<br />100000 Div 10 Misc M
<br />1,800.00
<br />17
<br />221316 Underground Plumbing
<br />6,070.00
<br />6,070.00
<br />18
<br />221116 Water
<br />9,850.00
<br />1,970-00
<br />19
<br />221316 Waste & Vent
<br />3,760.00
<br />20
<br />224000 Plumbing Fixtures Mat!
<br />2,400.00
<br />21
<br />224000 Plumbing Fixtures Labor
<br />4,650-00
<br />22
<br />230000 HVAC Material •-
<br />4,500.00
<br />23
<br />'230000 HVAC Lat)bf
<br />4,200.00
<br />24
<br />260000 Undepratir{ld/Site Elect
<br />13,570.00 9,998.38
<br />3,571-62,
<br />25
<br />053Z Fled -hough In Mad
<br />-
<br />3,000.00
<br />.�.
<br />.. GRAND TOTAL
<br />10,200.00
<br />'100.00
<br />510.00
<br />13,674.66
<br />50.46
<br />13,425,34
<br />683.74
<br />15,300.00
<br />l 4-.00
<br />1,700.00
<br />765.00
<br />8,040.00
<br />67":00
<br />3,960.00
<br />402.00
<br />8,000.00
<br />5,760.00
<br />80.00
<br />1,440.00
<br />288.00
<br />3;900.00
<br />50.00
<br />3,900,00
<br />195.00
<br />160.00
<br />50.00
<br />150.00
<br />7.50
<br />5,300.00
<br />12, 000.00
<br />7,500.00
<br />4,500.00
<br />6,000.00
<br />5,500.00
<br />1,800.00
<br />6,070-00
<br />100.00
<br />303.50
<br />1,970.00
<br />20.00
<br />7,880.00
<br />98.50
<br />3,760.00
<br />2,400.00
<br />4,650.00
<br />4,500.00
<br />4,200.00
<br />1 :�,570.00
<br />100.00
<br />678.50
<br />I
<br />3,000.00
<br />CAUTION: You should sign an original AIA Contract Document, on which this text appears WRED. An original assures that changes will not be obscured
<br />AIA Document-43IM"-1992. Copyright01963,105,1966,1967,1970, 1978,1983 and 1992 by The American Institute of Architects, All rights reserved, WARNING: Title AlODocument is protected by U.S. Copyright
<br />Law and International Treaties. Unauthorized reproduction ordtatributton of this AIA®Document, or any portion of it; may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent
<br />possible under the law. Purchasers are permitted tD reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal
<br />counsel, copyeght@aia.org. 102MCD"
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