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-`vAIA Document G703" -1992
<br />Continuation Sheet
<br />AIA Document G702Tm-1W kApptication and Certificate for Payment, or G732Tm-2009, 6
<br />Application and Certificabe for
<br />Payment, Construction Manager as Adviser Edition, APPLICATi I1110:
<br />containing Coatt119tor's signed certification is attached.
<br />APPUCATION DATE: 12/27/2021
<br />In tabulations bellnv, amounts are in US dollars. KRIdD T0:
<br />12/27/2021
<br />Use ColuumI onContracts where variable retainaee for line irrms ma., anal.
<br />A
<br />B
<br />C
<br />D E
<br />G
<br />WORK.COMPLETED
<br />H
<br />I
<br />ITEM
<br />NO.
<br />DESCRIPTION OF WORK
<br />SCHEDULED
<br />VALUE
<br />MATERIALS
<br />PRESENTLY,
<br />TOTAL
<br />COMPLETED AND %
<br />BALANCE TO
<br />RETAINAGE
<br />FROMPREVIOUS
<br />APPLICATION
<br />THIS PERIOD
<br />STORED
<br />bi
<br />STORED TO DATE (G+C)
<br />FINISH
<br />(C- G)
<br />(If variable rare)
<br />(D + E)
<br />Not D or E)
<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 Mao
<br />3,000.00
<br />3,000.00
<br />3,000:00
<br />100.00 .
<br />150.00
<br />28
<br />262100 Service/Dist Labor
<br />4,400.00
<br />4,400.00
<br />4.400.00
<br />100 0A
<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 />1,250.00
<br />1,250:t)0
<br />50.00
<br />1,250.00
<br />62.50
<br />31
<br />311000 Erosion Lontfoi; Mob
<br />6,600.00
<br />6,600.00
<br />6; M&
<br />100.00
<br />330.00
<br />32
<br />.312000'Eorlhw."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 />i8,000.00
<br />2,000.00
<br />20,000.00
<br />100.00
<br />1,000.00
<br />34
<br />'321216 Asphalt Paving
<br />3,800.00
<br />3,800.00
<br />35
<br />329200 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 />12,000.00
<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 />16,166.44
<br />16,16,3.44
<br />100.00
<br />808.32
<br />39
<br />Change Order 3
<br />7,522.81
<br />6,018.25
<br />6,018.25
<br />80.00
<br />1,504.56
<br />300.91
<br />GRAND TOTAL
<br />291,151.25
<br />201,151.35
<br />41,190.00
<br />242,34135
<br />83.24
<br />48,809.90
<br />12,117.07
<br />CAUTION:
<br />You should sian an orloinal AIA centred
<br />n,,...— m
<br />,.,...a.r
<br />---- - --•- ••• ....a.,,w °soar rm erah cnanges unu not no obscured.
<br />AIA Document 67oa- -1992. Copyright 01983, 1985, 1966. 1967, 1970, 1978, 1983 and 1992 by The Amencan Insigute of Architects. All rights rssarved, WARNING: This A1011ocument Is protected by U.S. Copyright
<br />Law and International Treatises Unauthorized reproduction or distribution of this AIA ° Document, or any portion of R may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent
<br />Possible under the law. Purchasers are pematdd to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, a -mall The American Institute of ArchPoegs• legal
<br />counsel, copyrlght@eia.org.
<br />rmuemcaa
<br />
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