6-Form Application-for-Payment.xlsx
XLSX spreadsheet 32 KB Posted
- Attached to
- Riddle Community Schoolyard
- Solicitation number
- Not on record
- Issued by
- Pittsburgh City, Pennsylvania
About this file
This is an Application for Payment form (AIA Document G702/G703) used in construction contracting between the contractor, architect, and project owner for the Riddle Community Schoolyard Project located at Riddle Elementary School in Riddle, Oregon. The project is a collaborative effort involving Trust for Public Land (TPL), Riddle School District 70, and Riddle Elementary School. Sealed bids are due June 4, 2026 at 3:00 pm local time through PennBid, with a mandatory pre-proposal meeting scheduled for May 18, 2026 at 3:00 pm at the project location. Technical questions and requests for clarification must be submitted by May 22, 2026 at 5:00 pm local time. Construction is anticipated to begin in summer 2026. Bidding documents are available at no cost through the PennBid platform.
The Application for Payment form tracks the original contract sum, net changes by change orders, completed work and stored materials, retainage (held at 10.0 percent of completed work), and current payment due. The form includes certification by both the contractor and architect regarding work completion in accordance with contract documents and payment entitlement. The project is subject to Oregon prevailing wage rates under ORS 279C.800 to 279C.870, and bidders are responsible for evaluating compliance costs with applicable prevailing wage rates and state labor laws. Bidders should consult the Oregon Bureau of Labor and Industries website for current wage rates. TPL reserves the right to cancel or modify the solicitation at any time.
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Text version
Application
APPLICATION AND CERTIFICATION FOR PAYMENT PAGE ONE OF PAGES
TO: PROJECT: APPLICATION NO: Distribution to:
Address: OWNER
ARCHITECT
PERIOD TO: CONTRACTOR
FROM SUBCONTRACTOR: VIA ARCHITECT:
PROJECT NO:
CONTRACT FOR: CONTRACT DATE:
| CONTRACTOR'S APPLICATION FOR PAYMENT | The undersigned Contractor certifies that to the best of the Contractor's knowledge, | ||||||
| Application is made for payment, as shown below, in connection with the Contract. | information and belief the Work covered by this Application for Payment has been | ||||||
| completed in accordance with the 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 payment shown herein is now due. | |||||||
| 1. ORIGINAL CONTRACT SUM | $ | 0.00 | |||||
| 2. Net change by Change Orders | $ | 0.00 | SUBCONTRACTOR: | ||||
| 3. CONTRACT SUM TO DATE (Line 1 ± 2) $ | $ | 0.00 | |||||
| 4. TOTAL COMPLETED & STORED TO | $ | 0.00 | |||||
| DATE (Column G on G703) | By: | Date: | |||||
| 5. RETAINAGE: | |||||||
| a. | 10.0 | % of Completed Work $ | 0.00 | State of: | County of: | ||
| (Column D + E on G703) | Subscribed and sworn to before me this | day of | |||||
| b. | % of Stored Material $ | Notary Public: | |||||
| (Column F on G703) | My Commission expires: | ||||||
| Total Retainage (Lines 5a + 5b or | |||||||
| Total in Column I of G703) | $ | 0.00 | ARCHITECT'S CERTIFICATE FOR PAYMENT | ||||
| 6. TOTAL EARNED LESS RETAINAGE | $ | 0.00 | In accordance with the Contract Documents, based on on-site observations and the data | ||||
| (Line 4 Less Line 5 Total) | comprising the application, the Architect certifies to the Owner that to the best of the | ||||||
| 7. LESS PREVIOUS CERTIFICATES FOR | Architect's knowledge, information and belief the Work has progressed as indicated, | ||||||
| PAYMENT (Line 6 from prior Certificate) | $ | 0.00 | the quality of the Work is in accordance with the Contract Documents, and the Contractor | ||||
| 8. CURRENT PAYMENT DUE | $ | 0.00 | is entitled to payment of the AMOUNT CERTIFIED. | ||||
| 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ | 0.00 | ||||||
| (Line 3 less Line 6) | AMOUNT CERTIFIED . . . . . . . . . . . $ |
| CHANGE ORDER SUMMARY | ADDITIONS | DEDUCTIONS | (Attach explanation if amount certified differs from the amount applied. Initial all figures on this |
| Total changes approved | Application and onthe Continuation Sheet that are changed to conform with the amount certified.) | ||
| in previous months by Owner | $0.00 | $0.00 | ARCHITECT: |
Total approved this Month $0.00 $0.00 By: Date:
| TOTALS | $0.00 | $0.00 | This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the |
| Contractor named herein. Issuance, payment and acceptance of payment are without | |||
| NET CHANGES by Change Order | $0.00 | prejudice to any rights of the Owner or Contractor under this Contract. |
ContinuationSheet
| CONTINUATION SHEET | PAGE OF PAGES | |||||||||||||||||||||
| APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed certification is attached. | APPLICATION NO: | 0 | ||||||||||||||||||||
| APPLICATION DATE: | 12/31/99 | |||||||||||||||||||||
| In tabulations below, amounts are stated to the nearest dollar. | PERIOD TO: | 12/31/99 | ||||||||||||||||||||
| Use Column I on Contracts where variable retainage for line items may apply. | PROJECT NO: | 0 | ||||||||||||||||||||
| A | B | C | D | E | F | G | H | I | ||||||||||||||
| ITEM | DESCRIPTION OF WORK | SCHEDULED | WORK COMPLETED | MATERIALS | TOTAL | % | BALANCE | RETAINAGE | ||||||||||||||
| NO. | VALUE | FROM PREVIOUS | THIS PERIOD | PRESENTLY | COMPLETED | (G ÷ C) | (IF VARIABLE | |||||||||||||||
| APPLICATION | STORED | AND STORED | (C - G) | RATE) | ||||||||||||||||||
| (D + E) | (NOT IN | TO DATE | ||||||||||||||||||||
| D OR E) | (D+E+F) | Req#1 | Req#2 | Req#3 | Req#4 | Req#5 | Req#6 | Req#7 | Req#8 | Req#9 | Req#10 | Req#11 | Req#12 | Req#13 | ||||||||
| 1 | NAME OF ITEM: | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
2 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
3 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
4 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
5 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
6 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
7 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
8 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
9 NAME OF ITEM: $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
10 CHANGE ORDERS (IF APPLICABLE): $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
| PLEASE BREAKDOWN THE TOTAL SCHEDULED VALUE (INCLUDING CHANGE ORDERS) | |
| Total Labor: | $ - 0 |
| Total Materials: | $ - 0 |
| Total Tax: | $ - 0 |
| Total Scheduled Value: | $ - 0 |
| $ - 0 | $0 | $ - 0 | ||||||
| GRAND TOTALS | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | 0.00% | $ - 0 | $ - 0 |
Check (should be zeroes): 0 0 0 0
&"Arial,Regular"&6AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA® · © 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006-5232 &"Arial,Bold"&8G703-1992
File details come from the government source that posted it. Updated .