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' AlA Document G703" -1992
<br />Continuation Sheet
<br />AIA Document G702'M-19,02, Application and Certificate For Payment, or 0732r'M--2009, APPUCATM W 5
<br />Application and Certificate.,for Fayment, Construction Manager as Adviser Edition, 11292021
<br />wntaioing Contra. - - signed certification is attached. APPU- rw= DATE:
<br />In tabulations belewr;amounts are in US dollars. Pr;RIOD TA:
<br />Use Column 10.0 Contracts where variable retainaee for line items may annly
<br />A
<br />B
<br />C
<br />D
<br />r c.. r 0 rnwct.I nv:
<br />E
<br />l'
<br />_ G
<br />H
<br />I
<br />WORK COMPLETED
<br />ITEM
<br />NO.
<br />DESCRIPTION OF
<br />SCHEDULED
<br />MATERIALS
<br />PRESENTLY
<br />.TOTAL
<br />COMPLETED AND.
<br />%
<br />BALANCE TO
<br />RETAINAGE
<br />FROM PREVIOUS
<br />VALUE
<br />APPLICATION
<br />THIS PERIOD
<br />STORED
<br />STORED TO DATE
<br />(G+C)
<br />FINISH
<br />(C-G)
<br />af-blerate)
<br />(D+E)
<br />(Not inDorE)-
<br />(2)+E+F9
<br />01
<br />Permit, SAC Fee
<br />4.700.00
<br />4,700.00
<br />4,700.00
<br />100.00
<br />235.00
<br />02
<br />Bond, Insurance, Mobilize
<br />10,200,00
<br />10.200.00
<br />10,200.00
<br />100.00
<br />510.00
<br />03
<br />General Conditions
<br />27,100.00
<br />13,674.66.
<br />13,674.66
<br />.50.46,
<br />13,425-34
<br />683.74
<br />04
<br />024119 Demolition
<br />17,000.00
<br />15,300.00
<br />1.700.00
<br />17,000.00.
<br />1OD°:00
<br />850.00
<br />OS
<br />033000 Concrete
<br />12,000.00
<br />8,040.00
<br />3,960-00
<br />12,000:90
<br />100.00
<br />600.00
<br />06
<br />055000 Metal.Fabriodens
<br />8,000.00
<br />8,000.00
<br />07
<br />061000 Rough Carp entry
<br />7,200.00
<br />5,760.00
<br />72000
<br />6,480.00
<br />90.00
<br />720.00
<br />324.00
<br />08
<br />062013 Exterior Rinish Carp
<br />7,800.00
<br />3,900.00
<br />1,950.00
<br />5.850.00
<br />I 75.00
<br />1,950.00
<br />292.50
<br />09
<br />083313I.Access Doors
<br />300.00
<br />150.00
<br />150.00
<br />50.00
<br />150.00
<br />7.50
<br />10
<br />083313 Coiling Doors
<br />5,300.00
<br />1,32&00
<br />1.325.00
<br />25.00
<br />3,975.00
<br />116.25
<br />11
<br />092000 Gypsum Board
<br />12,000.00
<br />6,000.00
<br />6,000.00
<br />50.00
<br />6.000.00
<br />300.00
<br />12
<br />093000 Tile
<br />7,500.00
<br />7.500.00
<br />I
<br />13
<br />096500 Rubber Floor
<br />4,500.00
<br />4,500.00
<br />14
<br />097750 FRP
<br />6,000.00
<br />6,000.00
<br />15
<br />099100 Painting
<br />5,500.00
<br />5,500.00
<br />16
<br />100000 Div 10 Misc M
<br />1,800.00
<br />1,800.00
<br />17
<br />221316 Underground Plumbing
<br />6,070.00
<br />6,070.00
<br />6,070-00
<br />100.00
<br />303.50
<br />18
<br />221116 Water
<br />9,850.00
<br />1,970.00
<br />2,955-00
<br />4,925.00
<br />50.00
<br />4,925.00
<br />246.25
<br />19
<br />221316 Waste & Vent
<br />3,760.00
<br />3,760.00
<br />3,760.00
<br />100i013
<br />188.00
<br />20
<br />224000 Plumbing Fixtures Mall
<br />2,400.00
<br />21
<br />224000 Plumbing Fixtures Labor
<br />4,650.00
<br />2,400.00
<br />22
<br />2330000 HVAC Material
<br />4,500.00
<br />(
<br />4,650.00
<br />23
<br />230000 HVAC Labor
<br />4,200.00
<br />I 4,50000
<br />24
<br />260090 Underground/Site Elect
<br />13,570.00
<br />13,570.001
<br />13,570.00
<br />1OR00
<br />4,200.00
<br />678.50
<br />� 3. Elect Rough- In Mall
<br />3 000.00
<br />3,000.00
<br />-.
<br />31000.00
<br />10000
<br />150:00
<br />GRAND TOTAL
<br />CAUTION:
<br />You should sinn an ndninni ere r.,....e..•--
<br />- - - --- ----- --.. - ,.. a ,a.., arm, a,n r«... M, urrurrtar assures tnat cnanges will not be obscured.
<br />ALaw and IA Document G703- -1992 Copyright e 1963, 1965, 19M. 1967, 1970, 197a, 1983 and 1992 by The American Im9tute of ArchHecla. All right reserved. WARNING: This AIA! Document Is protected by U.S. Copyright
<br />possible International
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