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<br />Document G703.'m -1992
<br />Continuation Sheet
<br />AIA Document G702`rm-1991.Ap�libation and Certificate for Payment, or G732-1-2009, APPLICAT :hILi• 1022/2021
<br />Application and Certificsl�*or payment, Construction Manager as Adviser Edition,
<br />containing Contractor"'signed cartificatian is attached. APPLEA DATE: 10/22t2021
<br />In tabulations 11ef: ' wants are in US dollars. i m T0: 6484
<br />Use.Coltitutt I•on Contracts where variable retainage for line items may apply: ARCHITECTS PROJECT NO:
<br />A T B C- D B Ii G H I
<br />WORK COMPLETED
<br />ITEM —`! MATERIALS TOTAL
<br />NO. DESCRIPTION OF WORK SCHEDULED FROMPREVIOUS PRESENTLY COMPLETED AND % BALANCE TO i RETAINAGE
<br />'C
<br />APPLICATION THIS PERIOD STORED STORED TO DATE (G . FINISH
<br />�) (If variable role)
<br />(D+E) (Not inD.orE) (D+E+F) (C—G)
<br />1,
<br />,,•pi : _, t oug,,, inTabor-
<br />27
<br />�62100 Service/Distr Mall
<br />3,000.00o
<br />3,000.00
<br />28
<br />262100 Service/Dist Labor
<br />4,400.00
<br />29
<br />265100 Lighting Matl
<br />8,100.00
<br />8,100.00
<br />30
<br />265100 Lighting Labor
<br />2,500.00
<br />31
<br />311000 Erosion Control,'Mo4,
<br />6,600.00
<br />6,600.00
<br />32
<br />312000 EarthWo*.-ReTpovais
<br />8,000.00
<br />8,000.00
<br />33
<br />312000 Eat#,Work'.
<br />20,000.00
<br />15,000.00.
<br />3,000.00
<br />34
<br />321216AsphaltPaving
<br />3,800_00
<br />35
<br />92f10 Turf & Grasses
<br />4,600.00
<br />36
<br />' 331113 Water Distribution
<br />12,000.00
<br />9,600.00
<br />37
<br />Change Order 1
<br />. -738.00
<br />-738.00
<br />38
<br />Change Order 2
<br />16,166.44
<br />12,124.83
<br />39
<br />Change Order 3
<br />7,522.81
<br />2,256.84
<br />GRAND TOTAL
<br />_41 713 82
<br />3,000.00 '100.00
<br />8,100.00 100106
<br />6,6.0G:00 100.00
<br />:8- 'ba d 100.00
<br />18; 000.00 90.00
<br />9,600.00
<br />-738.00
<br />12,124.83
<br />2,256.84
<br />80.00
<br />100.00
<br />75.00
<br />30.00
<br />150.00
<br />4,400.00
<br />405.00
<br />2, 500.00
<br />330.00
<br />400.00
<br />2,000-00
<br />900.00
<br />3,800.00
<br />4,600.00
<br />2,400.00
<br />480.00
<br />-36.90
<br />4,041.61
<br />606.24
<br />5,265.97
<br />112.84
<br />CAUTION: You should sign an original AIA Contract Document, on which this text appears In RED. An original assures that changes will not be obscured.
<br />AIA Document 0703TM —1992, Copyright 01M. 1965, 1966, 1967, 1970, 1978. 1983 and 1992 by The American Institute ofArchilecls. AN rights reserved. WARNING: This me Document is protected by U.8, Copyright
<br />Law and International Treaties. Unauthorized reproduction or distribution of this A10 Document, or any portion of 11. may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
<br />possible under the law. Purchasers are permitted to 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, copyright@aia.org.
<br />iwli ocw
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