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U A Document G703" -1992
<br />Continuation Sheet
<br />ALA Document G702TL-1992. Application and Certificate for Payment or G732T -2009, APPLICATIOMNO: 5
<br />Application and Certifier is -for Payment, Construction Manager as Adviser Edition, App EA DATE: 11rz9J2021
<br />containing Contractor's signed certification is attached
<br />In tabulations bcl0w„ amounts are in US dollars. FFRM TO:
<br />Use Column I on,Contracts where variable retitinage for line items may aDDly. s or•urrer no non rerr ►rn.
<br />A
<br />B
<br />C --
<br />D E
<br />P--
<br />_- G
<br />H
<br />I
<br />WORK COMPLETED
<br />ITEM
<br />DESCRIPTION OF WORK
<br />SCHEDULED
<br />MATERIALS
<br />PRESENTLY
<br />TOTAL
<br />COMPLETED AND
<br />%
<br />BALANCE TO
<br />RETAINAGE
<br />FROMPREVIOUS
<br />-
<br />VALUE
<br />APPLJCA71ON
<br />THIS PERIOD
<br />STORED
<br />STORED TO DATE
<br />(G+C)
<br />FINISH
<br />(C-G)
<br />(Ifvariablerase)
<br />(D+E)
<br />(Not inDorE)
<br />(D+E+F)
<br />26
<br />260533 Rough in Labor
<br />6,300.00
<br />6,300-00
<br />6,300.00
<br />100.00
<br />315.00
<br />27
<br />262100 Service/Distr Matl
<br />3,000,00
<br />3,000.00
<br />3.000.00
<br />100.00
<br />150.00
<br />28
<br />2621OO Service/Dist Labor
<br />4,400.00
<br />4,400,00
<br />4,400.01)
<br />100:OD
<br />220.00
<br />29
<br />265100 Lighting Matl
<br />8,100.00
<br />8,100.00
<br />8,100.00
<br />100.00
<br />405.00
<br />30
<br />265100 Lighting Labor
<br />2.500.00
<br />I
<br />2,500.00
<br />31
<br />311000 Erosion COnt�ol, Mob
<br />6,600.00
<br />6,600.00
<br />6;606.00
<br />100.00
<br />330.00
<br />32
<br />312000 Earthwork Removals
<br />8,000.00
<br />8,000.00
<br />-8,000.00
<br />100.00
<br />400.00
<br />33
<br />312000,Earthwork
<br />20,000.00
<br />18,000.00
<br />18,000.00
<br />90.00
<br />2,000.00
<br />900.00
<br />34
<br />.321216Asphalt Paving
<br />3,800.00
<br />3,800.00
<br />35
<br />�29200 Turf & Grasses
<br />4,600.00
<br />4.600.00
<br />4,600.00
<br />100.00
<br />230.00
<br />36
<br />331113 Water Distribution
<br />12,000.00
<br />9,600.00
<br />2.400.00
<br />12,000.00
<br />100.00
<br />600.00
<br />37
<br />Change Order 1
<br />-738.00
<br />-738 00
<br />-738.00
<br />100.00
<br />-36.90
<br />38
<br />Change Order 2
<br />16,166.44
<br />12,124.83
<br />4,041-61
<br />16,166.44
<br />100.00
<br />808.32
<br />39
<br />Change Order 3
<br />7,522.81
<br />2,256.84
<br />3,761.41
<br />6,018.25
<br />80.00
<br />1,504.56
<br />300.91
<br />carrriner.
<br />GRAND TOTAL
<br />v., er....aa -,-
<br />291,151.25
<br />150,27833
<br />50.873.02
<br />—
<br />201,151.35
<br />-
<br />69.09
<br />89,999.90
<br />10,057.5T
<br />-- -------•- -•_•• -••-••„•••-• ^ ^ •...a . •.. W.•=,,,, vu n,nurr uos roar appears to rccu. An original assures that changes will not be obscured.
<br />AIA Document QM- -1992 CopyrlghtO 19M,1965, 1956.1967. 1970, 1978, 1903 and 1992 by The American Institute of Amhitac ts. All rights reserved. WARMe NO: This -Al Dommeht Is protected by U.S. Copyright
<br />Law and International Trestles. Unauthorized reproduction or distribution 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 uPurchasers are permittbd to reproduce ten (10) coples of this document when completed. To report eopydghiviolations of AIA Contract Documents, e.mal The American InstlMe of Architects' legal
<br />counsel, nyd��a rg.
<br />,mraww•
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