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HomeMy WebLinkAboutERMCO, INC. - 1006 - 183,194.52 - 8/2/2010 • ° -AIA Document G702/CMaT" — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition 36 TO OWNER: Carmel Redevelopment CommispROJECT: Parcel 7A, Regional Performing ArtsAPPLICATION NO: 25 f} Distribution to: 1 Civic Square Center Interior Rough PERIOD TO: 5/3112010 OWNER ❑ Carmel, IN 46032 Construction Package P4 CONSTRUCTION MANAGER ❑ FROM CONTI2eg t INC. VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ P.O. Box 1507 Shiel Sexton PROJECT NOS: 2695-4320 / CONTRACTOR ❑ Indianapolis, IN 46206 VIA ARCHITECT: FIELD ❑ CSO Architects CONTRACT Fctrical Installation Project#25310H ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below, in connection with the Contract belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet.AIA Document G703.is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM 7„505,000.00 payment shown herein is now due. 2. Net change by Change Orders $(467,808.00) CONTRALTO ERMCO; I 3.CONTRACT SUM TO DATE(Line I ±2) 1,037,192.00 By: • - Date: 5/14/2010 4.TOTAL COMPLETED&STORED TO DATE(Cnlunut G on G703) 6448,296.27 State of: Indiana 5.RETAINAGE: County of: Marion .. a. %of Completed Work Subscribed and sworn to before (Column D+Eon G703) 351,859.60 me this 14th day of �M(ay, 2010 n 4 n b. %of Stored Material Notary Public: d��• ��-5 '^�'� (Column F on G703) $ My Commission expires: 12/19/2015 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 351]8 c:1 Fn CERTIFICATE FOR PAYMENT .. In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 6,096.436.67 this application,the Construction Manager and Architect certify to the Owner that to the best of their (line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated.the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 5,913,242.15 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 2 1 8.CURRENT PAYMENT DUE $ 183 194.52 AMOUNT CERTIFIED $ 03 7,1 p_`.`t 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanarbn if amount cerified differs from the amount applied. Initial all figures on this Application and m the Cr nrinuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 940 755.33 CONSTRUCTI4 MAN• - /-- By: A /7,-- 4: _.. Date: 7 • a. . aD/O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE to TT G �7 Total changes approved in previous months by Owner 1751,499 no l6�9,a07_00) By: ���' /`' Date: J-C�q' tfi Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor • - TOTALS 17,499 no X639,307_0a)_) named herein. Issuance. payment and acceptance of payment are without prejudice to any rights of NET CHANGES b Change Order $ ) the Owner or Contractor under this Contract PAID D > g (467.808.00_ r+ AU6 - 4 2010 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. AIA Document G702/CMaie—1992.Copyright ®1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA°Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA° Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel,copyright @aia.org. =crif AI Document G702/CMa" - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the 67021CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and 6703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). (1' Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. `L Change Orders:Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more:Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. E.Making Payment • . • The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager alpi Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains the name andaddress of the Contractor.Payment,should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G7021CMaTa—1992.Copyright ®1992 by The American Institute of Architects.All rights reserved.WARNING:This AIRS Document Is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIRS Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel,copyright@aia.org. ERMCO Contract 2695-4320 = =AIA Document G703'N I!- 1992 124070 Continuation Sheet ALA Document 0702.APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 25 containing Contractor's signed certification is attached. APPLICATION DATE: 5/13/2010 In tabulations below-amounts arc stated to the nearest dollar. Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO: 5/31/2010 ARCHITECT'S PROJECT NO: A B C D I E F G I I 1 WORK COMPLETED MATERIALS TOTAL BALANCE FROM PREVIOUS PRESENTLY COMPLETED RL-TAINAGE SCHEDULED „ '1'0 I'T'EM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (C=C) FINISH (NOT IN TO DATE RATE) (D+E) DOR E) (0+E-fir) (C-G) 00.001 MOBILIZATION 15,000.00 15,000.00 15,000.00 100 b0.002 i 1 P.M. 200,000.00 168.284.00 5.286.00 173.570.00 87 26,430.00 0.003 DAD ENG 80.000.00 80,000.00 80,000.00 100 0.004 TEMP-L 75.000.00 68,578.00 2.500.00 71,078.00 95 3,922.00 0.005 TEMP-M 45,000.00 42,625.00 500.00 43,125.00 96 1.875.00 i 150.006 CLEAN UP ,000.00 10.420.00 1.000.00 1 1.420.00 76 3,580.00 0.007 ,OND 72.00400 72.00(1.00 72,000.00 100 10.008 ESTING 18,000.00 12,000.00 12,000.00 67 6,000.00 00.009 SITE OFFICE 23,000.00 22,300.00 100.00 22.400.00 97 600.00 60.010 DEMOBILIZATION 5.000.00 5,000.00 0.011 ALLOWANCE 12 550,000.00 381,772.00 52,000.00 433,772.00 79 1 16.228.00 0.012 ALLOWNACE 13 350,000.00 263,926.75 6,658.52 270,585.27 77 79,414.73 0.013 )(ALLOWANCE 14 100,000.00 75,000.00 75.000.00 75 25.000.00 0.014 ALLOWANCE 15 5.000.00 5,000.00 5,000.00 100 0.015 LLOWANCE 16 10.000.00 10,000.00 10,000.00 100 0.016 0.11 40.017 AT 10,000.00 10,000.00 10.000.00 100 • )0.018 LABOR 6,000.00 6,000.00 6.000.00 100 )0.019 EXCAVATION 35.000.00 35.000.00 35,000.00 100 10.020 F0.12 )0.025 BRANCH R- M 500.00 500.00 500.00 100 )0.026 BRANCH R- L 1,500.00 1,500.00 1.500.00 ! 100 )0.027 BRANCH F-M 100.00 • 100.00 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. AIA Document G703*"—1992.Copyright CO 1963. 1965,1966,1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties.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 possible under the law.Purchasers are permitted to reproduce ten 110)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. ='tAIA Document G703TM- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.A IA Document G702.Application and Certificate for Payment,is to be used in conjunction with AIA Document 0703,Continuation Sheet.These documents arc designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AL\Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document.nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed 0703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission front the A IA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement(HULA).To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects' legal counsel.copyrightaaia.org. COMPLETING G703-1992 Heading.This information should he completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A, II& C.These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may he by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should he used when required. Column C should he subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of column C Amy be adjusted by Change Orders during the Project. Column I). Enter in this column the amount of completed Work covered by the previous application(columns D& F. from the previous application). Values from column F(Materials Presently Stored) from the previous application should not be entered in this column. Column E.Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F.Enter here the value of Materials Iresently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period,This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed—This Period.) Column C.Enter here the total of columns I), E and F. Calculate the percentage completed by dividing column G by column C. Column II.Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retninage is permitted on a line-item basis. It need not be completed on projects where a constant retai nape is withheld from the ove'all contract atnonnt. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own 0703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to he entered in the appropriate location on the 6702 form, Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A2111. The following is an crumple„fa Corrtinlration Sheet Jill.mark in prvgrels. Please note that dollar arnuuatr Jnnen hdmr are for inns franca purpose,.'only.and are not intended to reflect actual construction(nal). A It C 1, I! F I. n I YuNI;IONI'l l'f l'11 \I UIiRJALS 1 1AI. enLA1:I t P0.F11iRELT poiti iF SA1NAG[ I1 L.1.1 [t HFp11LF.0 FRf 11 NEr'IUI1S •. II, AEI. Ilt\,'NII'lli l\"UF WORK \'.\LUIi nPPLILA'l l(ii\ llllv'1'Fltll,p S11R11N AND 0.FD l'1 IlA'L II IIP VARIAaL1. 40' (NOT IN Tr'ti'r,. - RATE) L) DORIS) iP.lp11 lC.al 1 MOBILIZATION 5,000 5,000 0 5,000 100 0 2 STImP REMOVAL 5000 5,010 0 5,000 100 0 3 EARTH WORK 15,000 10. 00 5.000 15,000 100 0 I LOWER RETAINING WALL 10.000 5,000 5.000 50 5.000 5 CURBS 6 MISC.CONC. 5,000 0 0 0 5000 6 PAVING.UPPER DRIVE 20000 0 0 0 20,000 7 P AVING,LOWER DRIVE 20000 0 0 0 20,000 8 PAVERS 20000 0 10,000 10000 50 10,000 9 BRICK WORK 5,000 0 0 0 5,000 10 11 105.000 20.000 10000 10,000 60.000 65,000 AIA Document G703111—1992.Copyright©1963, 1965,1966, 1967,1970, 1978.1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AleDocument is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel,copyright @aia.org. T ® ERMCO Contract 11 2695-4320 :blitz 12407D A Document G70G703" — AA^ AI Continuation Sheet l�{�L AIA Document 6702.APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 25 containing Contractor's signed certification is attached. APPLICATION DATE: 5/13/2010 In tabulations below,amounts are stated to the nearest dollar. 5/31/2010 Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G _ H 1 WORK COMPLETED MATERIALS 'IOIAL — - BALANCE SCHEDULED PRESENTLY COMPLETED RETAINAGE FROM PREVIOUS tit, TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION 'fills PERIOD (NOT IN TO DATE (t;+C) FINISH RATE) (D+E) DORE) (D+E+F) (C-G) 00.028 BRANCH F- L 200.00 200.00 00.029 E1.01 r0.030 FEEDER M 975,000.00 975.000.00 975.000.00 100 10.031 FEEDER L 600.000.00 600.000.00 600_.000.00 IOU 10.032 E1.02 10.033 0 M 250.000.00 248,000.00 1.000.00 249,000.00 100 1.000,00 10.034 Q L 150,000.00 147.000.00 1500.00 148,500.00 99 1,500.00 1 40.035 E1.03 40.036 p0 R-M 10,000.00 10,000.00 10,000.00 100 10.037 1 Q R- L 15,000.00 15,000.00 15.000.00 100 00.038 EQ F - M 30,000.00 29,000.00 2_9,000.00 97 1.000.00 00.039 EQ F- L 8,000.00 6,500.00 6,500.00 81 1,500.00 00.040 E1.04 00.041 0 R-M 10.000.00 10,00000 10,000.00 100 00.042 1 Q R- L 15,000.00 13500.00 750.00 14,250.00 95 750.00 00.043 EQ F- M 25,000.00 23.000.00 23,000.00 92 2,000.00 00.044 IEQ F- L 8,000.00 7.000.00 7,000.00 88 1,000.00 00.045 1 1.05 00.046 EQ R-M . 5,060.00 5.000.00 5.000.00 100 00.047 IEQ R- L 5.000.00 3,000.00 1,000.00 4,000.00 80 1.000.00 00.048 IEQ F- M 35.000.00 32500.00 32.500 00 93 2,500.00 00.049 EQ F- L 8,000.00 7,000.00 7,000.00 88 1.000.00 10.050 E2.00&A& P 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. AIA Document G703TM-1992.Copyright @ 1963, 1965,1966,1967,1970, 1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlAeDocument Is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlAe Document,or any portion of it,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent 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,email The American Institute of Architects'legal counsel,copyright @aia.org. AIA Document G7031M- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. A IA Document G702,Application and Certificate for Payment,is to he used in conjunction with A IA Document 6703,Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A20I,General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not he reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document,The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies ofa completed 6703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of A IA software. Licensed AIA sofiware users should consult the End User License Agreement(LULA).To report copyright violations of A IA Contract Documents,c-mail The American Institute of Architects'legal counsel.copyright@aia.org. COMPLETING G703-1992 (leading.This information should he completed in a manner consistent with similar information on AIA Document 6702.Application and Certificate for Payment. Columns A, B& C.These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may he by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of column C may be adjusted by Change Orders during the Project. Column D. Enter in this column the amount of completed Work covered by the previous application(columns I)& E from the previous application). Values from column F(Materials Presently Stored)Boni the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F), Column F. Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must he recalculated at the end of each pay period.This value covers boll materials newly stored Mr which payment is sought and materials previously stored which arc not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into col unit) E(Work Completed—This Period.) Column C. Enter here the total of columns D, F and F.Calculate the percentage completed by dividing column G by column C. Column II. Enter here the difference between column C(Scheduled Value)and column Ci(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract:amount. Change Orders.Although Change Orders could he incorporated by changing the schedule of values each time a Change Order is added to the Project.this is not normally done. Usually.Change Orders arc listed separately.tither on their own Ci703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives.Amounts not in dispute that have been included in Construetiuu Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is an example of o Continuation Sheer for work in progress.Place none that dollar amounts shown below ore Jar illustrative purposes only,cud ore not inmmdel to reflect actual construction wary. A WORE(°I19191n •MATERIAI-S 101AI. NA I.ANI Ii IRI FTTLT lN>IIII'TFD NITNVMiR I ELM SCMI.ED FWI\IIREValS 1: In DI'bLNll'IL IV UI'MONx r RFD \YD 1l RED nF\ARL1111.Y. NO l',\I.IfE \PPI.I[ATION TIIIS I'INli"n f0•II IIJIYII ID-HI (NOT El 10 DATE li,.O1 RATE)IN I,OR F,1 ,D•RO1 MOBILIZATION 5000 5000 0 5000 10) STUMP REMOVAL 5,000 5000 0 5,000 100 0 EARTH WORK 15,000 10,000 5000 15000 100 0 LOWER RETAINING WALL M,000 5,000 5,000 50 5.000 CURBS&MISC,CONC. 5,000 0 0 0 5,000 PAVING,UPPER DRIVE 20,000 0 0 0 20,000 PAVING,LOWER DRIVE 20.000 0 0 0 20,000 PAVERS 20000 0 10000 10,000 50 10000 BRICK WORK 5,000 0 0 0 5,000 1 11 105 000 20.000 10,000 10000 40000 5 000 AIA Document G703"-1992.Copyright @ 1963, 1965.1966, 1967.1970, 1978. 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel.copyright @aia.org. e ® ERMCO Contract ll 2695-4320 • wiAIA Document G7O3TM — 1992 124070 Continuation Sheet A1A Document 6702.APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 25 containing Contractor's signed certification is attached. APPLICATION DATE: 5/13/2010 In tabulations below,amounts are stated to the nearest dollar. 5/31/2010 Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C 0 I E F G H I WORK COMPLETED MATERIALS TOTAL I BALANCE SCHEDULED PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OF WORK FROM PREVIOUS °o 'TO VALUE STORED AND STORED (IF VARIABLE NO. APPLICATION 'PHIS PERIOD (NOT IN TO DATE (G+C) FINISH RATE) (D+E) D OR E) (D+E+F) (C-Ci) 10.051 RIGGING 35,000.00 35,000.00 35,000.00 100 10.052 IEQ R- M 30.000.00 30.000.00 30,000.00 100 10.053 EQ R- L 20,000.00 19,000.00 19,000.00 95 1.000.00 10.054 ED F- M 575,000.00 572.500.00 572,500.00 100 2,500.00 00.055 0 F- L 30,000.00 26.500.00 26,500.00 88 3,500.00 10.056 RANCH R-M 17,000.00 17.000.00 17,000.00 100 0.057 RANCH R- L 13,000.00 12.300.00 12300.00 95 700.00 10.058 RANCH F-M 7,000.00 6.000.00 6,000.00 86 1.000.00 0.059 BRANCH F- L 5,000.00 3,500.00 3,500.00 70 1.500.00 10.060 EEDER R-M 550.000.00 550,000.00 550.000.00 100 10.061 EEDER R- L 250;000.00 250,000.00 250,000.00 100 0.062 FEEDER F- M 6,000.00 6,000.00 6,000.00 100 0,063 EEDER F- L 10,000.00 10,000.00 10.000.00 100 )0.064 E2.01 E2.02 10.065 IGGING 10.000.00 10,000.00 10.000.00 . 100 10.070 BRANCH R- M 15,000.00 15,000.00 15,000.00 100 0.071 BRANCH R- L 8.000.00 7.080.00 7,080.00 89 920.00 0.072 BRANCH F-M 2.500.00 2.000.00 2,000.00 80 500.00 0.073 BRANCH F - L 3,500.00 1.500.00 1,500.00 43 2,000.00 30.074 E2.03 &A )0.075 BRANCH R- M 20.000.00 18.900.00 18.900.00 95 1,100.00 )0.076 BRANCH R- L 16,000.00 14,320.00 14,320.00 90 1.680.00 30.077 BRANCH F.- M 1.000.00 1.000.00 1,000.00 100 CAUTION:You should sign i ou d s g an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G703" —1992.Copyright 0 1963,1965, 1966,1967, 1970,1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document Is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel,copyright @aia.org. • ' AIA Document G703"— 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents, AIA Document 0702.Application and Certificate for Payment.is to be used in conjunction with AIA Document(1703,Continuation Sheet.These documents arc designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A20 I,General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any A IA Contract Document, users should consult www.aia org or a local AIA component to vent fy the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the A IA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The A IA hereby grants the purchaser a limited license to reproduce a maxi MUM of ten copies of a completed 0703,but only for use in connection with a particular project.The Alt\ will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users ofA IA software. Licensed AIA software users should consult the End User License Agreement(EULA I.'I'o report copyright violations of A IA Contract Documents,c-mail The American Institute of Architects'legal counsel.copyright@aia.org. aia.org. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar information on AlA Document 0702.Application and Certificate for Payment. Columns A,B& C.These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. initially,this total should equal the original Contract Sum.The total of column C may be adjusted by Change Orders during the Project. Column I). Enter in this column the amount of completed Work covered by the previous application(columns I)& E from the previous application).Values from column F(Materials Presently Stored) from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F. Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must he recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored inaterin Is does not result in a deduction trout this col unm.Only as materials are incorporated into the Project is their value deducted trotn this Column and incorporated into column E(Work Completed—This Period.) Column C.Enter here the total of columns D, E and F.Calculate the percentage completed by dividing column G by column C. Column II.Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not he completed on projects where a constant retainage is withheld from the overall contract amount, Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own 6703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to he entered in the appropriate location on the G702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should he incorporated into one or more Change Orders.Amounts remaining in dispute should he dealt with according to Section 7.3 in A201. The fhllomi,rg is an example of a Continuation Sheet for work in progress.Please note lbw dollar amounts shown below ore f n-illustrative purposes only,and Ore not intended to reflect actual construction COOS. A n C w E F n u W.RK(AGII'o GI r'II LATE RIMS TOTAL 11\I.Ar•1:1: IRI TAIL\' 1'(�\IPI ETEU RI TAINALiI ITEM DESCRIPTION 11 VDRR stormurut RIIPREVIOUS 1'1'.0.1[III SIORE AND STORED „„Ht. I Ilr 'ARIARLE Nn, VALUE APPLICATION 115 111,61 U(T IN 70 DATE 1',__ RATFI Ii 00 E) Ip-E-Fr 1 MOBILIZATION 5.000 5.000 0 5000 100 2 STUMP REMOVAL 5.000 5,000 0 5000 100 0 3 EARTH WORK 15,000 10,000 5.CO 15.000 1011 0 4 LOWER RETAINING WALL 10,000 0 5,000 5.000 50 5000 5 CURBS&MISC.LONG, 5,000 0 e 0 5.000 6 PAVING,UPPER DRIVE 20000 0 0 0 20,000 7 PAVING,LOWER DRIVE 20000 0 0 0 20000 8 PAVERS 20,000 0 10.000 10.003 50 10000 9 BRICKWORK 5,000 0 0 0 5.000 10 11 105000 20,000 10,000 10.000 40,000 65.000 AIA Document 6703TM-1992.Copyright ITS 1963,1965,1966,1967, 1970,1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Al eDocument,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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,email The American Institute of Architects'legal counsel,copyright @aia.org. -AIAT ® M ERMCO Contract # 2695-4320 Document G703 — 1992 124070 Continuation Sheet ALA Document 6702,APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 25 containing Contractor's signed cenification is attached. APPLICATION DATE: 5/13/2010 In tabulations below, amounts are stated to the nearest dollar. Use Column Ion Contracts where variable rctainage for line items may apply. PERIOD TO: 5/31/2010 ARCHITECT'S PROJECT NO: A B C D I E F G H I WORK COMPLETED MATERIALS TOTAI. BALANCE PRESENTLY COMPLETED RETAINAGE „ ITEM DESCRIPTION OF WORK SCHEDUI-ED FROM PREVIOUS „ TO STORED AND STORED (IF VARIABLE VALUE APPLICATION TIIIS PERIOD (G+C) FINISH NO. (D+EI (NOT IN TO DATE (C-C) RATE) D OR E) (D+E+F) 00.078 BRANCH F- L 2,500.00 750.00 750.00 30 1,750.00 00.079 FEEDER R-M 65,000.00 65.000.00 65,000.00 100 00.080 FEEDER R-L 45,000.00 45,000.00 45.000.00 100 00.081 FEEDER F-M 2500.00 2,500.00 2.500.00 100 00.082 FEEDER F- L 5.000.00 5.000.00 5.000.00 100 )0.083 E2.04 00.084 BRANCH R- M 6,000.00 5,170.00 5,170.00 86 830.00 00.085 BRANCH R - L 8.000.00 6,860.00 6.860.00 86 1,140.00 00.086 BRANCH F- M 1.000.00 750.00 750.00 75 250.00 )0.087 BRANCH F-L 2,500.00 1,200.00 1,200.00 48 1.300.00 00.088 E2.05 )0.089 BRANCH R -M 15.000.00 14,050.00 14,050.00 94 950.00 )0.090 BRANCH R- L 14,000.00 11,780.00 1,000.00 12,780.00 91 1220.00 )0.091 BRANCH F- M 800.00 800.00 10.092 BRANCH F- L 1.500.00 1.500.00 10.093 E2.06 30.094 BRANCH R-NI 4,000.00 2.030.00 1.000.00 3,030.00 76 970.00 p0.095 BRANCH R- L 6,000.00 4,200.00 1,000.00 5,200.00 87 800.00 b0.096 BRANCH F- M 600.00 600.00 [10.097 BRANCH F- L 1,200.00 1,200.00 10.098 E2.07 30.099 BRANCH R-M 8,000.00 7.060.00 7.060.00 88 940.00 J0.100 BRANCH R-L 10,000.00 8500.00 1,000.00 9,500.00 95 500.00 CAUTION:You should sign an original NA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G703TM—1992.Copyright©1963,1965.1966, 1967, 1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document Is protected by U.S.Copyright Law and International Treaties.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 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 counsel,copyright @aia.org. SALk Document G703"1- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.A IA Document 0702,Application and Certificate for Payment, is to be used in conjunction with AI.A Document 0703,Continuation Sheet.'these documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in MA Document A201,General Conditions of the Contract for Construction. Use of Current Documents.Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verily the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted front without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703,but only for use in connection with a panicular project.'The Ale will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the A IA. Rights to reproduce the document may vary for users of A IA software. Licensed A IA software users should consult the End User License Agreement(HULA).To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright LSaia.org. COMPLETING G703-1992 Heading.This information should he completed in a manner consistent with similar information on AIA Document 0702.Application and Certificate for Payment. Columns A, B& C.These columns should he completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may he by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should he subtotaled at the bottom when more than one page is used and for led on the last page. Initially.this total should equal the original Contract Sum.The total of column C may be adjusted by Change Orders during the Project. Column U.Enter in this column the amount of completed Work covered by the previous application(columns I)& E rota the previous application). Values from column F(Materials Presently Stored) from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F. Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must he recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column G(Work Completed—This Period.) Column C.Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H.Enter here the difference between column C(Scheduled Value)and column C(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not he completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could he incorporated by changing the schedule of val lies each time a Change Order is added to the Project,this is not normally done.Usually.Change Orders are listed separately,either on their own 0703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the 0702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The fallowing is an example of a Continuation Sltect lhr work in progr ics. Please rote that dollar amounts shown below ore jar illustrative purposes only,told are not intended to reflect actual Cnratr'uetion cost.. A PORK('RAIN MID MATERIALS 101St. IIFSIFTI.1' AND SP RErnIV.1GF IrEf SCIIEDUt.l'D FR, PREV1oUS Y. fV NO, U6CRIITION OF KbNK pAl11E APPLII'AIIUF Tills Pp NIOO STORED AND i RED D„� 1f9I511 IiIF VAR IAD LE INOT I9 ID DATE - RATIO rU.W DEMF.I (D.E,L1 If.-GI I MOBILIZATION 5000 5,000 0 5,000 100 0 2 STUMP REMOVAL 5000 5,000 0 5,000 100 0 3 EARTH WORK 15,000 WOW 5,030 15,000 100 0 4 LOWER RETAINING WALL 10,000 5,000 5000 50 5,000 5 CURBS d MISC.CONC. 5000 0 0 0 5030 6 PAVING,UPPER DRIVE 20,000 0 0 0 20000 7 PAVING,LOWER DRIVE 20,000 0 0 0 20,000 A PAVERS 20,000 0 10,000 10000 50 10.000 9 BRICK WORK 5,000 0 0 0 5,000 10 II _ 105000 20,000 10,000 10, 00 40000 65,000 AIA Document G703'v—1992.Copyright©1963, 1965,1966, 1967, 1970, 1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA°Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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,email The American Institute of Architects'legal counsel,copyright @aia.org. ERMCO Contract # 2695-4320 A Document G703" - 1992 124070 Continuation Sheet AIA Document 0702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 25 containing Contractor's signed cenification is attached. APPLICATION DATE: 5/13/2010 In tabulations below.amounts are stated to the nearest dollar. 5/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F O H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED ,,, RETAINAGE SCIIEDIII-ED FROM PREVIOUS .� TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION TIIIS PERIOD (NOT IN 'I'U DATE RATE) :C) FINISH RA"rr:) fD+LI D ORE) ID+E+F) IC-G) 00.101 BRANCH F-M 1,000.00 1.00000 00.102 BRANCH F- L 2,500.00 2.500.00 00.103 E2.07A 00.104 BRANCH R-M 15,000.00 12,550.00 1,200.00 13.750.00 92 1,250.00 00.105 BRANCH R- L 20,000.00 17500.00 1.200.00 18.700.00 94 1.300.00 00.106 BRANCH F- M 9.000.00 6500.00 6.500.00 72 2,500.00 )0.107 BRANCH F - L 10,000.00 6,500.00 6.500.00 65 3,500.00 10.108 E2.08 10.109 BRANCH R- M 6.000.00 4.920.00 500.00 5.420.00 90 580.00 10.110 BRANCH R- L 8,000.00 7,000.00 500.00 7500.00 94 500.00 10.111 BRANCH F-M 2.000.00 1.000.00 1,000.00 50 1,000.00 0.112 BRANCH F- L 3_,500.00 1.500.00 1.500.00 43 2,000.00 10.113 E2.09 10.114 EQ R- M 8.000.00 8,00000 8,000.00 100 10.115 EQ R - L 10,000.00 10,000.00 10,000.00 100 0.116 EQ F - M 2500.00 2,500.00 2,500.00 100 10.117 EQ F- L 3.000.00 2.000.00 2,000.00 67 1.000.00 JO.I IS E2.10 10.119 BRANCH R- M 1,000.00 1,000.00 1.000.00 100 J0.120 BRANCH R- L 2500.00 1.500.00 500.00 2.000.00 80 500.00 10.121 BRANCH F-M 100.00 - 100.00 )0.122 BRANCH F-L 500.00 500.00 J0.123 EQ R- M 6.000.00 6,000.00 6,000.00 100 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. AIA Document G703TM—1992.Copyright 01963, 1965, 1966,1967, 1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale'Document Is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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,a-mail The American Institute of Architects'legal counsel,copyright @aia.org. - T '=AlA Document G701"- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AlA Document 6702,Application and Certificate for Payment, is to he used in conjunction with AIA Document 0703.Continuation Sheet.These documents arc designed or use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in A IA Document A20I.General Conditions of the Contract for Construction. Use of Current Documents.Prior to using any AIA Contract Document, users should consult www.aia.org or a local MA component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in'the American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed (1703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA, Rights to reproduce the document may va'v Mr users of AlA software. Licensed AIA software users should consult the End User License Agreement(FULA).To report copyright violations of MA Contract Documents.e-mail The American Institute of Architects'legal counsel,copyright @aia.org. COMPLETING G703-1992 Heading.This information should he completed in a manner consistent with similar infomation on MA Document 0702,Application and Certificate for Payment. Columns A, Ii& C.These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should he used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially.this total should equal the original Contract Stan.The total of column C may be adjusted by Change Orders during the Project. Column D.Enter in this column the amount of completed Work covered by the previous application(columns I)& 13 from the previous application). Values from column F(Materials Presently Stored) from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application- including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F. Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column F(Work Completed—This Period.) Column C. Enter here the total of columns D, li and P.Calculate the percentage completed by dividing column C by column C. Column Ii. Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retain age is permitted on a line-item basis. It need not he completed on projects where a constant retainaae is withheld front the overall contract:mount. Change Orders-Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own 6703 norm or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to he entered in the appropriate location on the(1702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change 1/ircetives should be incorporated into ouc or more Change Orders. Anloullt2 remaining in dispute should be dealt with according to Section 7.3 in A201. 7hejidlau'ing is an crumple of ConlLtutrlio rl Sbre!f r Durk in progress.Please note Anal dollar amounts.shown below arc JOr illlrsbmive purposes only,and area not intended to reflect actual construction casts. A e r Il I': F 11 II 10iLK CO\IPL191''U MAT I RIAII 1 FAI If.\I.AACF PW IMIALS Cl mlllllfl RI I'AI\Aril: II1111 klll'.UUL1.11 I RD IIRI 'P:NUS TD UE1fRI1IlU]O!'WJRC II(RI.1 Al 4101010 OF VARIAIILI'. VALUP. ,\YPLI(. 'l ll1�' (III\I'1!KI(�D lop IN 1'II DA II. Ili+l'I FINISH pATl:l iNOT Li op III 10,1,17 ill-O] 1 MOBILIZATION 5,000 5,000 5000 I00 0 2 STUMP REMOVAL 5.000 5,000 5.000 100 0 3 EARTH WORK 15000 1000 5,00 15000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 5.000 50 5,000 5 CURBS d MISC.CONC. 5.000 0 0 0 5000 6 PAVING.UPPER DRIVE 20,030 0 0 0 20,000 7 PAVING,LOWER DRIVE 20000 0 0 0 2000) B PAVERS 20000 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 5000 10 11 _ 105.000 20000 10000 10.000 40000 65,00 AIA Document G7O3TM-1992.Copyright©1963,1965, 1966,1967. 1970,1978. 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlA®Document is protected by U.S.Copyright Law and International Treaties.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 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 counsel,copyright @aia.org. ERMCO Contract if 2695-4320 *AIk Document G7031M - 1992 124070 Continuation Sheet AIA Document G702.APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 25 containing Contractor's signed certification is attached. APPLICATION DATE: 5/13/2010 In tabulations below,amounts are stated to the nearest dollar. 5/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A R C' D E F O H I WORK COMPLETED MATERIALS TOTAL BALANCE FROi\1 PREVIOUS PRESENTLY" COMPLETED RETAINAGE SCHEDULED 7o TO ITEM DESCRIPTION OF WORK STORED ANll S'hOREU (IF VARIABLE NO. VALUE APPLICA'T'ION THIS PERIOD (NOT IN 9'O DATE (G>Cj FINISH RATE) (D+E) DORE) (D+E+F) (C-G) 00.124 EQ R- L 10.000.00 4.500.00 2500.00 7.000.00 70 3,000.00 00.125 FQ F-M 1.500.00 1.500.00 10.126 Q F- L 2.000.00 2,000.00 00.162 1E4.00&A& P 00.163 SOUND R-M 75,000.00 73,500.00 750.00 74,250.00 99 750.00 00.164 iSOUND R- L 60,000.00 57,500.00 1,500.00 59,000.00 98 1,000.00 )0.165 E4.01 &A )0.166 (SOUND R- M 40.000.00 37.000.00 1.500.00 38,500.00 96 1,500.00 00.167 SOUND R- L 25.000.00 24,000.00 500.00 24,500.00 98 500.00 00.168 E4.02 &A 00.169 SOUND R- M 40.000.00 35.800.00 2.000.00 37.800.00 95 2,200.00 00.170 SOUND R- L 25.000.00 17.000.00 4,000.00 21,000.00 84 4.000.00 00.171 E4.03 00.172 SOUND R- M 25.000.00 23,000.00 1.000.00 24.000.00 96 1,000.00 )0.173 SOUND R- L 18,000.00 13,400.00 2,000.00 15,400.00 86 2,600.00 )0.174 E4.04 )0.175 SOUND R- M 25.000.00 23,500.00 750.00 24.250.00 97 750.00 10.176 SOUND R- L 18.000.00 17,000.00 500.00 17500.00 97 500.00 )0.177 E4.05& .06& .07 & .09 0.178 SOUND R-M 80,000.00 74,600.00 2.500.00 77,100.00 96 2,900.00 r0.179 SOUND R- L 65,000.00 59500.00 2.500.00 62,000.00 95 3,000.00 0.180 E5.00& P 10.181 F.A. R -M 15.000.00 13,250.00 1.000.00 14,250.00 95 750.00 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. AIA Document G703T"—1992.Copyright©1963, 1965. 1966,1967. 1970, 1978. 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlAeDocument,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel,copyright @aia.org. 9' AIA Document G703TM- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.A IA Document 6702, Application and Certificate for Payment,is to be used in conjunction with A IA Document 6703,Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201,General Conditions of the Contract for Construction. Use of Current Documents.Prior to using any AIA Contract Docment. users should consult www.aia.org or a local A IA component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not he reproduced or excerpted from without the express written permission of the MA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement(EULA).To report copyright violations of AIA Contract Documents,e-mail The American Institute of.Architects legal counsel.copyright jaia.org. COMPLETING 6703-1992 Heading.This information should be completed in a manner consistent with similar inhumation on AIA Document 6702,Application and Certificate for Payment. Columns A,B& C.These columns should he completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of'col unml C nary be adjusted by Change Orders during the Project. Column D. Enter in this eolumn the amount of completed Work covered by the previous application(columns D& I'i from the previous application). Values from column F(Materials Presently Stored)from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F. latter here the value of Materials Presently Stored for which payment is sought.The total of the column nest be recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column G(Work Completed—This Period.) Column G.Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H. Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Colman I.This column is normally used only for contracts where variable retainage is pennitte(I on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could he incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own('i71)3 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the 6702 Bunn. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should he incorporated into one or more Change Orders.Amounts remaining in dispute should he dealt with according to Section 7.3 in A201. The following is an example of Con(luualinn Sheet Jhr work in progress.Plea■0 more that dollar amounts shown below are At-it&rstrativ a purposes only.and an- nul intended to rdleet actual COI1SPP'aatioll costs. A WORK Ce1Vl'llil'Y NM-TRIALS 01,0. M W:Y 1.10 SRN II.Y IYl\IITPi En NI VARIAl:l': so. St„Ault l'!n I'1101.100\'In115 Tn NO. P19t'RIYl10NUV N'OI<K ynLUP, \PPLII{l1aN 1'1115 VFRlan VORFn ,{Nlltt RRD I,•,I FINI,UI 'll'\\RIpNI.P. it e! lN(a E) Inli\TF, tC-lit XAT r.I 111!R EI 11 00•10 MOBILIZATION 5,000 5.000 0 5,000 100 0 STUMP REMOVAL 5,000 5.000 0 5,000 100 0 EARTH WORK 15000 10000 5,000 15.000 100 0 LOWER RETAINING WALL 10000 5,000 5.000 50 5,000 CURBS d MISC.CONC 5,000 0 0 0 5,000 PAVING,UPPER DRIVE 20,000 0 0 0 20,000 PAVING,LOWER DRIVE 20,000 0 0 0 20000 PAVERS 20,00.' 0 10000 10,000 50 10.000 BRICK WORK 5,000 0 0 0 5,000 11 105,000 20,000 10,000 10000 10000 65,030 AIA Document G703T"-1992.Copyright©1963,1965, 1966, 1967, 1970, 1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA°Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AleDocument,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel.copyright @aia.org. ERMCO Contract # 2695-4320 SALk Document G703Ta — 1992 124070 Continuation Sheet AIA Document 0702.APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 25 containing ContraLloT s s1 ned:eisrification is attached_ APPLICATION DATE: 5/13!2010 In tabulations betoty.ain0unts arc stated to the nearest dollar. 5!3112010 Use Column Ion Contracts where variable rewinu2c for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLE'T'ED MATERIALS 'TOTAL BALANCE SCHEDULED PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OF WORK FROM PREVIOUS 7 TO STORED AND STORED _ VARIABLE. NO (NO IN TO VALUE APPLICATION THIS PERIOD 'C DATE 10+ ) FINISH RATE) (I]+L-) UORE) (D+E+F (C-G) 0.182 =.A. R-L 9,000.00 8,000.00 100.00 8,500.00 94 500.00 4.182 =.A. F - M 20,000.00 15,000.00 1.500.00 16,500.00 83 3500.00 0.184 =-A. F-L 1.000.00 5,000.00 0.185 E 5.01 & .02& .03 (31 86 =.A. R - M 17.000.00 14,840.(10 1.000.00 15 840.00 93 1,160.00 0.187 F.A. R- L 10.000.00 7500.00 750.00 8.250-00` 83 1,750 00 U 188 A F-M. 20,000-00 15,000.00 1,500,00 16,SO11_U0 83 3,500.00 b 189 A. F-L 5,000.00 5-000-00 00.190 5.04 & .05& .06 10.191 -'F.A. R-M 20,000.00 17,900.00 1,000.00 18,900_00 95 1,100.00 0-192 F.A. R-L 17.000.00 11000.00 3.000.00 14.000.00 82 3.000.00 0.193 F.A. F-M 20.000-00 15,000.00 2,500.00 17,500.00 88 2,500,00 10.194 F.A. F - L 5,00000 5,000.00 10,195 E5.07 & .08& -09 & .10 10,196 F.A. R-M 20.00000 17,400,00 1.000-00 18,40400 92 1,600.00 0.197 F.A. R-L 15.000.00 12.000-00 750.00 12.750.00 85 2,250.00 4.198 F.A. F-M 16,000.00 1 1,000,00 2,500.00 13,500.00 84 2.500.00 0.199 F.A. F- L 3,000,00 3.00000 0.200 E6-02 0241 EQ M _ SS,000 0 t 10.000.00 2.500.00 52,500.0(1 • 9� 2.500.00 0202 EQ L 20,000.00 110090 7.500.00 12.500.00 63 7,500.00 0 293 CABLE M 35,000 00 30,0011-QO 2,500,00 32;500 00 93 2,500-00 0.204 CABLE L' 45,000.00 000.00 15,400.00 20;000.(H1 44 25.000.00 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. AIA Document G703ra-1992.Copyright©1963,1965,1966, 1967,1970,1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAeDoeument is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possIble under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations el AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. = =ATA Document G703"- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AIA Document 6702, Application and Certificate Ior Payment,is to he used in conjunction with A IA Document G703,Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner.Procedures for their use are covered in ALA Document A201-General Conditions of the Contract for Construction. Use of Current Documents. l'rior to using any A IA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition, Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the espress written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any archer rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed 0703-but only for use in connection with a particular project The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights 10 reproduce the document may vary for users of A IA soltwate. Licensed AIA software users should consult the End User License Agreement(ELLA). To report copyright violations of ALA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright rriaiu-org. COMPLETING G703-1992 Heading.This information should be completed in a manlier consistent with similar information on AIA Document 0702, Application and Certificate for Payment. Columns A,II&C.These columns should he completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project Multiple pages should he used when required. Column C should be subtotaled al the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the I'ratect. Column D. Enter in this column the amount of completed Work covered by the previous application(columns I)& F from the previous application)-Values from column F(Materials Presently Stored)from the previous application should not he entered in this column. Column E.linter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials I'resently Stored(celunm F). Column F. Enter here the value of Materials Presently Stored 1-m'which payment is sought.The total of the column must be recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into die Project is their value deducted from this column and incorporated into column E(Work Completed=]-his Period.) Column C.Enter here the total of columns I), hi and F.Calculate the percentage completed by dividing column G by column C. Column H,Enter here the difference between column C(Scheduled Value)and colunhn 0(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could he incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own 0703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location oil the G702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should he incorporated into one or more Change Orders.Amounts remaining in dispute should he dealt with according to Section 7.3 in A2111, Tire follo.viag is an runulple n/■Cwninaa(10 I Sheer jrn'x'ai*rn progress. Plensnr now that tin ¢rturnuNS shown below tn'■}ar Ilhcrirm ht.purposes nnA,and are trot nit❑nded In reflect menial COnso'ricnon cuvix. A n ,, a j e r mu ii 01RKti)mit]'Li] -pl\Ill ssr AI,1w C- 1010055,v ',VI II.x REfAINL[l 1151 144CI it SCIIRDa.ln 10 00 1,5701011E V.W F 111LCm 1mN i1M1 P1l(Inn 1 N5 1 070 tl rINIiH nF1\RIABLL N 10 DATE iNg RA r Ll RI+Fi ,1.- 01014 (un•••) t MORILtZArrON 5,004 50011 V 5000 loo 0 2 STUMP REMOVAL 5000 5000 0 5.000 104 0 3 EARTHWORK 6,000 10.003 5000 15000 100 U 4 LOWER RETAENIN6 WALL 10.000 5,004 5000 54 5004 5 CURBS 04155.CON[, 5,000 0 ❑ 0 5000 6 RAVINE.,LPPER!DRIVE 20000 0 0 0 30000 7 PAVING.LOWER DRrvE 20000 0 0 0 00000 B PAVERS 20.000 0 10000 10,000 50 10[00 9 BRICK WORK 5.000 0 0 0 5,030 14 n 105 000 20000 10 000 10.000 4,007 ri$eaa AIA Document G7031e-1992.Copyright©1963,1995,1966, 1967,1570, 1976.1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlAabocument is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlAa'Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document whorl completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel.capyrigMQaie.org. • v ® ERMCO Contract 1l 2695-4320 = AIA Document G703'M - 1992 124070 Continuation Sheet AIA Document 0702,APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION N0: 25 containing Contractor's signed certification is attached. APPLICATION DATE: 5/13/2010 In tabulations below.amounts are stated to the nearest dollar. 5/31/2010 Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D I E F G H t WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED PRESENTLY COMPLETED RETAINAGE rPEM DESCRIPTION OF WORK FROM PREVIOUS % TO STORED AND STORED OF VARIABLE NO. VALUE APPI.ICATION THIS PERIOD (NOT IN TO DATE (G+C) ELVISH RATE) (D+El D OR E) ID+E+FT (C-G) 00.205 1SR M 5.000.00 100.00 100.00 2 4.900.00 00.206 GR L 2.000.00 2,000.00 00.207 E6.03 00.208 'SECURITY R-M 40,000.00 25,800.00 25,800.00 65 14.200.00 0.209 SECURITY R- L 20,000.00 1 1,000.00 1 1.000.00 55 9,000.00 0.210ECURITY F- M 18.000.00 18,000.00 0.211 ECURITY F- L 6,000.00 6.000.00 0.212 1 6.05 00213 DIMMING M 60.000.00 57.000.00 57,000.00 95 3.000.00 I 0.214 DIMMING L 45,000.00 33,350.00 2,000.00 35,350.00 79 9,650.00 00.215 E6.06 00.216 OPTIC SENSOR M 8.000.00 8.000.00 8,000.00 100 00.217 OPTIC SENSOR L 4,000.00 1,000.00 1.000.00 25 3.000.00 0.218 'E7.09 0.219 S & C M 100.000.00 95,000.00 1,000.00 96.000.00 96 4.000.00 0.220 S & C L 80,000.00 66500.00 4,000.00 70.500.00 88 9,500.00 0.221 E8.00 0.222 LIGHTNING PRO M 42.000.00 34,800.00 7.200.00 42.000.00 100 0.223 LIGHTNING PRO L 18,000.00 14.700.00 3,300.00 18.000.00 100 0.224 ALLOWANCE 17 40,000.00 10,765.00 10,765.00 27 29.235.00 00.225 (CHANGE ORDER#1 $0.226 IOCULUS ALTERNATE 1.000.00 1.000.00 1.000.00 100 $0227 CHANGE ORDER#2 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. AIA Document G703*0—1992.Copyright©1963,1965,1966,1967,1970,1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlAe Document is protected by U.S.Copyright Law and International Treaties.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 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 counsel,copyright@aia.org. AIDocument G703"— 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.A IA Document G702,Application and Certificate for Payment, is to he used in conjunction with A IA Document 6703.Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A2t)I,General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document,users should consult www.3 ia.org or a local AIA component to verify the most recent edition. Reproductions.This document is a copyrighted work and nay not he reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed 6703,but only for use in connection with a particular project.The AlA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request aid receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AlA software, Licensed AlA software users should consult the End User License Agreement(EULA).To report copyright violations of A IA Contract Documents.e-mail The American Institute of Architects'legal counsel.copyright@aia.org. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A, II& C.These columns should be completed by identifying the various portions of'the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may he by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially.this total should equal the original Contract Sum.The total of colunm C may be adjusted by Change Orders during the Project. Column I).Enter in this column the amount of completed Work covered by the previous application(columns D& E from the previous application). Values from column F(Materials Presently Stored) from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Column F. Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must he recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed—This Period.) Column C. Enter here the total of columns D.E and F.Calculate the percentage completed by dividing column G by column C. Column II. Enter here the difference between column C(Scheduled Value)and column G (Total Completed and Stored to I)ate). Column I.This column is normally used only for contracts where variable rctiinage is permitted on a line-item basis. It need not be completed on projects where a constant retai nage is withheld from the overall contract amount. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually.Change Orders are listed separately-either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the Ci702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should he incorporated into one or ntore Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A20 I. 77/e/Mowing 1.r an example nl'a Cnntimmtirur S'le'et lily work in progress. P/core awe that dollar anuumtr.chown below are fin.illustrative purposes only,and are not intended to reflect octal cune'n'uetiuu coxtt. A WORK FQNPJ IgfU '1AI FRIAL5 TOTAL NAW' PRESENTLY uI, .11l'.O RF.I\I\',\(it. III:\I ]elll',IIUI Fn 1'NIN PRFV NILI 4 IO \'ll nl_KMII'IIO.;,IL 4\'ORA VALUE APPLICATION 1111)'1'I NIIAII tl RFD ,AND)1(X1'.11 Ili'1 II:LSII tIF\VARIABLE IIOR IN TOIAP I: I R,\rl:l I Em DOREi ID,I■PI IC n MOBILIZATION 5,000 5100 0 5000 100 0 STUMP REMOVAL 5Px1 5000 0 5000 100 0 EARTH WORK 15.000 10,000 5,000 15000 100 0 LOWER RETAINING WALL 10,000 5,000 5,000 50 5,000 CURBS 6 MIS•C.CONC, 5000 0 0 0 5.000 PAVING,UPPER DRIVE 20,000 0 0 0 20.000 PAVING,LOWER DRIVE 20.000 0 0 0 20000 PAVERS 20,000 0 10,000 10,000 50 10,000 BRICK WORK 5000 0 0 0 0 5,000 1 1 105,000 20.000 10,000 10,000 40000 65,000 AIA Document G7031"–1992.Copyright 0 1963, 1965, 1966, 1967, 1970. 1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlAeDocument is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA°Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent 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 counsel,copyright @aia.org, v ® ERMCO Contract # 2695-4320 01 AIA Document G703" - 1992 124070 Continuation Sheet AIA Document 6702. APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: 25 containing Contractor's signed certification is attached. APPLICATION DATE: 5/13/2010 In tabulations below.amounts are stated to the nearest dollar. 5/31/2010 Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G Ii I WORK COMPLETED MATERIALS TOTAI, BALANCE SCHEDULED FROM COMPLETED RETAINAGE FROM PREVIOUS 9u TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD 10+C) FINISH NO. (NOT IN TO DATE - RATE) if)+E) DORE) (D+E+F) IC-G) 1 00.228 MACHINELESS ELEVATOR 11.500.00 11.500.00 11.500.00 100 00.229 CHANGE ORDER#3 00.230 RCP 4 (58,852.00) (58,852.00) (58.852.00) 100 00.231 CHANGE ORDER#004 NO COAT 00.232 CHANGE ORDER#005 )0.233 ASI-037, RCP-006 23,177.00 19.500.00 19,500.00 84 3,677.00 )0.234 CHANGE ORDER#006 10.235 RCP-011 (7.554.00) (7.554.00) (7.554-00) 100 0.236 CHANGE ORDER#007 0.237 ASI-038 18.12.00 16.500.00 16.500.00 88 2,232.00 0.238 CHANGE ORDER#008 0.239 ALLOWANCE 4320A ELEC GENET (350,000.00) (350.000.00) (350.000.00) 100 10.240 ALLOWANCE 4330A FIRE ALARM (75.000.00) (75,000.00) (75,000.00) 100 10.241 ALLOWANCE 4330B FIRE/SECU9 (5,000.00) (5.000.00) (5.000.00) 100 10.242 ALLOWANCE 4320D ELECTRICAL (10.000.00) (10.000.00) (10.000.00) 100 10.243 BOND REDUCTION FOR ALLOW 1 (2.715.00) (2.715.00) (2,715.00) 100 0.244 CHANGE ORDER#009 10.245 WORK DIRECTIVE 4320-001 NEV% 00.246 CHANGE ORDER#010 I 30.247 ASI-PAC-104 WATER HEATER.AD 17.090.00 12,000.00 12.000.00 70 5,090.00 30.248 E3.03 D0249 LIGHTING R-M 30.000,00 27,700.00 1.500.00 29.200.00 97 800.00 100.250 LIGHTING R-L 35.000.00 29.500.00 1,500.00 31.000,00 89 4.000.00 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. AIA Document G703TM—1992.Copyright®1963,1965,1966,1967. 1970, 1978. 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document Is protected by U.S.Copyright Law and International Treaties.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 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 counsel,copyright @aia.org. , 1 Document G701M- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AIA Document 6702, Application and Certificate for Payment. is to he used in conjunction with A IA Document 6703,Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A20 I,General Conditions of the Contract for Construction. Use of Current Documents. l'rior to using any A IA Contract Document,users should consult www.ain.org or a local Al A component to verity the most recent edition. Reproductions.This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any flintier rights to reproduce this document.The AlA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed 6703,but only for use in connection with a particular project.The AlA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the A IA. Rights to reproduce the document may vary for users of A IA software. Licensed A IA software users should consult the End User License Agreement(EULA).To report copyright violations of AIA Contract Documents.e-mail The American Institute of Architects'legal counsel.copyright@aia.org. COMPLETING G703-1992 (leading.This information should be completed in a manner consistent with similar information on AIA Document(.1702,Application and Certificate for Payment. Columns A, B& C.These columns should he completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may he by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should he used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially.this total should equal the original Contract Sum.The total of column C may he adjusted by Change Orders during the Project. Column D. Enter in this column the amount of completed Work covered by the previous application(columns D& E from the previous application). Values from column F(Materials Presently Stored) from the previous application should not be entered in this column. Colman E. Enter here the value of Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Colunui F.Enter here the value of Materials Presently Stored for which payment is sought.'fhe total of the column must be recalculated at the end of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed—This Period.) Column C. Enter here the total of columns I), E and F.Calculate the percentage completed by dividing column 6 by column C. Column II. Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall eon tract amount. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually.Change Orders are listed separately,either on their own 6703 form or at the end of the basic schedule, The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the 6702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A20 I. The/idlnming iv an example of a Cnaligrmlion Sheri fin.'cork it progir■,. !leave note that dollar amounts shown heluu•are Jhr illustrative purposes only.and are nor!wended to r Jleci netuul ennsOroenO!t costs A II I. u C r 0 u I M01111 COMPLI'] 0 rAi ER IALS T it I. • PH!\fV'IL1' CO7 rAL HI!11N,CAGF. ITIIAI SCIII'lltll ltd I,U LICA Il.i Y. 0 OESeHIPIII!V ON 10 IRK rO1 IN AND DAL 1.: CY VARIABLE yO vn LUl Au ue\nuN nlu mlxluo 4ie np'IVn In■1.1 DOR IN TO OH1BIC Ifli, 0.nl l!I u ox Bt. fmisPl • MOBILIZATION 5,000 5,000 0 5000 100 0 STUMP REMOVAL 5,000 5.000 0 5000 100 0 EARTH WORK 15,000 10,000 5,000 15,000 100 0 LOWER RETAINING WALL 10000 5,000 5,000 50 5000 CURBS d MISC.CONC. 5,000 0 0 0 5.000 PAVING,UPPER DRIVE 20,000 0 0 0 20,000 PAVING,LOWER DRIVE 20000 0 0 0 20000 PAVERS 20000 0 10,000 10000 50 10,090 BRICK WORK 5,003 0 0 0 0 5,000 11 105,000 20000 _ 10,000 10,000 40,000 65.000 AIA Document G703i'-19921 Copyright C.1963,1965. 1966.1967, 1970,1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright Law and International Treaties.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 possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AlA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. . ° 2695-4320 ERMCD Contract If SAJi Document G703" - 1992 124070 Continuation Sheet AIA Document 6702.APPLICATION AND CFR]'IFICATION FOR PAYMENT, APPLICATION NO: 27 Containing Contractor rsigned certification is attached_ APPLICATION DATE: 5113/2010 In tabulations below,amounts are slated to the nearest dollar. Use Column I on Contracts whet(amiable ret:tinugc for line items may apply. - PERIOD TO 5/31/2010 ARCHITECT'S PROJECT NO A B C D I E F 6 H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED PRESENTLY COMPLETED r,, RFTAINAGI FROM PREVIOUS ,o TO ITEM DESCRIPTION OF WORK STORED AND STORED HE VARIABLE NO (NOT APPLICATION THIS PERIOD {NUT IY 'I'O DATE (O:C) FINISH RATE) (La+E) DORL') 0:)+E+17) (C-G7 )025 I LIGHTING F-M 350.000.00 325,678.00 15.000.00 340,67X00 97 9,322.00 10.252 LIGHTING F - L 22.000.00 7500.00 1,000.00 8.500.00 39 13.500.00 NI 253 CHANGE ORDER #11 - 60254 ALLOWANCE FROM 43208 ALLO' 000,000.00) (100000.00) (100.00000) -:100 30.255 ALLOWANCE TO 4320A ALLOW 1 100,000.00 ]00,000.00 100.000.00 , too 500.256 ALLOW REDUCTION 4320B ALLO (30.000.00) (30.000-00) (30000.00)100 00257 BOND REDUCTION (186.00) (186.00) - _ (186 OW 100 7,037.19200 6.265.101.75 183,19432 6.448,29627 92 588.895.73 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. AIA Document GMT"-1992.Copyright 1963.1965,1966, 1967,1970,1978, 1983 and 1992 by The American Institute el Architects.All rights reserved.WARNING:This AlAe Document is protected by U.S.Copyright Lew and international Treaties.Unauthorized reproduction or distribution of this AIAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(1 op copies at this document when completed.To report copyright violations of AIA Contract Documents.e-mail The American Institute of Architects'legal counsel,copyrightChaia.erg. 1i$ AIi& Document G703"— 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AlA Document 0702, Application and Ccnl ficate for Payment,is to be used in conjunction with AIA Document 0703,Continuation Sheet.These documents are designed fur use on Projects where the Contractor has a direct Agreement with the Owner.Procedures for their use arc covered in AlA Document A201,Crcneral Condtions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Docuntcut users should consult www.aia.org or a local Al A component to verify the most recent edition. Reproductions.This document is a copyrighted work and may not he reproduced or excerpted front without the express written permission of the A IA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The Al A hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed 0703,but only for use in connection with a particular project_l'he A IA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the A IA. Rights to reproduce the document may vary for users of AEA software.Licensed A IA software users should consult the End User License Agreement t hULA)_To report copyright violations of AlA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright riaaia_org. COMPLETING GT03-1992 Heading.This in lamination should he completed Etl a manner consistent with similar information on AIA Document 0702. Application and Certificate for Payment. Columns A,B &C.These columns should be completed by identifying the various portions of the Project and thee scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.'the breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project_Multiple pages should he used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of column C may be adjusted by Chance Orders during the Project. Column D.Enter in this column the amount of completed Work covered by the previous application(columns D& E from the previous application).Values from column F(Materials Presently Stored) from the previous application should net be entered in this column. Column IC Enter here the value of Work completed at pre time tilling application,including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored(column F). Cole rim F.Enter here the value of Materials Presently Stored for which payment is sought_The total of Illy column must be recalculated at the cod of each pay period.This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this colmn.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column F(Work Completed—This Period.) Column C.Enter here the total of columns D,A and F.Calculate the percentage completed by dividing column C by column C. Column II.linter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where.variable rctainuge is permitted 00 a line-item basis_ It need not be completed on projects where a constant is withheld from the overall contract amount_ Change Orders,Although Change Orders could he incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders arc listed separately,either on their own 6703 form or at die end of the basic schedule. The amount of the original contract adjusted by Change Orders is to he entered in the appropriate location on the 6702 form. Construction Change Directives. Amounts nut hi dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The Jnllmring Crap example.TTa Coirro rurliou S7leetjor troth In progrcns. Please trade Ara duAur ulwmntc s/na'n below are fin-rlhrii,'alire purpncns only. and ale not inledukel re ryfleci octal!eine:JI 1:111 M cu■C9_ n u C u rl P n II 1 r'VImtr r nl11'llTii) I IIII Ld T„LAr M1lF. IIJ I,'lIV I:fiNIII51' II FT INA,.E ITEM SCITEUULEII 1A NI ILIL.2IOUS "ry r [AIECNIPTION OY N'OAF 'JAI IIn ,1Fn r]Itlll, OVA,RIAeLE NO. .LF APPLICATION T]IIS Vr.H1116 rS, rli\' r, �Ih LO+( .O. p,STF.I lb LE) 001(Ii) Il iE01 (C.O. 1 MOBILIZATION 5000 5,090 5.000 100 2 STUMPREMOVAL 5,000 5,000 5.000 100 0 3 EARTH WORK 19,000 10, 00 5. CO 15,000 100 0 4 LOWER RETAaJIUS WALL 10000 5,000 5,000 50 5000 5 CURBS 6 MISC.CONC. 5000 0 0 5000 6 PAVING,UPPER DRIVE 20,000 0 0 21.000 7 PAVING,LOWER DRIVE 20000 0 0 20.000 a PAVERS 20000 10,000 10,000 10 10,000 9 ERIC¢WQRC 5000 0 0 0 5,000 10 105000 20000 10,000 10,000 40000 55200, AIA Document G703T"—1992.Copyright 91963, 1965,1966,1967. 1970, 1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIAx Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce tan 1101 copies of this document when completed_To report copyright violations or AIA Contract Documents.e-mail The American Institute of Architects'legal counsel,copyright c aiaorg, AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA ) Final Partial X )SS: COUNTY OF MARION ) Rod Burton being duly sworn states that he is the Controller of ERMCO, INC. having contracted with City of Carmel (124070.025) to furnish certain materials and /or labor as follows: Electrical Installation for a project known as Parcel 7A. Regional Performing Arts Center Interior Rough Construction Package P4 located in Carmel. IN and does further state: PARTIAL WAIVER: That the balance due from the owner is the sum of ONE HUNDRED EIGHTY THREE THOUSAND ONE HUNDRED NINETY FOUR DOLLARS AND 52/l00($183.194.521 the receipt of which is hereby acknowledged: or X the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: FINAL WAIVER: That the final balance due from the owner is the sum of receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and • for said amount, effective upon receipt of such payment: THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien and claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. ERMCO. INC. by ;522.--dareat Rod Burton Controller Witness my hand and notarial seal, this 14°i day of May, 2010 Notary Public My Commission Expires: 12/19//2015 Lou Anne Puckett Notary Public-Printed Signature County of Residence: Marion Proscribed by Slate Board olAccounls Oily Form No,201,;Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Fr•enf a , /ti z , Purchase Order No. la e oX /5-0 7 Terms //,‘774-74/904-...5 /4/ 1/62-06 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) $/3/X& 2Q7 /97,/4-0,4-0,7 15/9 fi (?3,/31<52 Total /&3/95'-52 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5-11-10-1,6, , 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 .Croyd % - IN SUM OF $ /96' 72' /5c7 %/Yd. a, 4od > /A V6 2/}� $ lga /9ft' z ON ACCOUNT OF APPROPRIATION FOR Board Members PO#Of INVOICE NO. ACCT#!TITLE AMOUNT hereby certify ( ) DEPT x I hereb certi that the attached invoices , or 9oz 25/.x' vv&,o&Cr 7 i83,l995-2- bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except G-9 2DG Director olSlopment Cost distribution ledger classification if Title claim paid motor vehicle highway fund