14. Pay App Sample.xls
XLS spreadsheet 49 KB Posted
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- General Construction IDIQ
- Solicitation number
- 6973GH-18-R-00008
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14. Pay App Sample (xls)
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Text version
G702
| APPLICATION AND CERTIFICATE FOR PAYMENT | PAGE 1 OF 2 PAGES | ||
| TO: | PROJECT: | APPLICATION NO: | DISTRIBUTION TO: |
| PERIOD TO: | OWNER | ||
| PROJECT NO: | ARCHITECT | ||
| CONTRACT DATE: | CONTRACTOR | ||
| FROM: | VIA ARCHITECT: | ||
| CONTRACT FOR: | |||
| 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 | information and belief the Work covered by this Application for Payment has been completed | ||
| Contract Continuation Sheet, is attached. | 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 | |||
| 1. ORIGINAL CONTRACT SUM........................……...…$ | 0.00 | received from the Owner, and that current payment shown herein is now due. | |
| 2. Net Change by Change Orders & Extras...….…..…$ | 0.00 | CONTRACTOR: | |
| 3. CONTRACT SUM TO DATE (Line 1+2)......……....…$ | 0.00 | ||
| By:_________________________________________ Date______________ | |||
| 4. TOTAL COMPLETED & STORED TO DATE….…....$ | 0.00 | ||
| (Column G on G703) | State of: | ||
| County of: | |||
| 5. RETAINAGE: | |||
| a. % of Completed Work | Subscribed and sworn to before me this day of , | ||
| b. % of Stored Material | |||
| Total in Column I of G703)...................….....……..…......$ | 0.00 | Notary Public: | |
| My Commission Expires: | |||
| 6. TOTAL EARNED LESS RETAINAGE........…….….…$ | 0.00 | ||
| (Line 4 less Line 5 Total) | ARCHITECT'S CERTIFICATE FOR PAYMENT | ||
| In accordance with the Contract Documents, based on on-site observations and | |||
| 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT.... $ | 0.00 | the data comprising this application, the Architect certifies to the Owner that to | |
| (Line 6 from prior Certificate) | the best of the Architect's knowledge, information and belief the Work has | ||
| progressed as indicated, the quality of the Work is in accordance with the | |||
| 8. CURRENT PAYMENT DUE.............................….....…$ | 0.00 | Contract Documents, and the Contractor is entitled to payment of the AMOUNT | |
| CERTIFIED. | |||
| 9. BALANCE TO FINISH, INCLUDING RETAINAGE…..$ | 0.00 | ||
| ( Line 3 less Line 6) | AMOUNT CERTIFIED.........................................................$_______________________ | ||
| ARCHITECT: | |||
| CHANGE ORDER SUMMARY | By:__________________________________________ Date:____________________ | ||
| Total changes approved in | |||
| previous months by Owner……………………………..….....$ | $0.00 | This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to | |
| Total approved this month………………...………………..…$ | $0.00 | the Contractor named herein. Issuance, payment and acceptance of payment | |
| are without prejudice to any rights of the Owner or Contractor under this | |||
| NET CHANGES by Change Order……………….………..….$ | $0.00 | Contract. |
G703
| CONTINUATION SHEET | PAGE 2 OF 2 PAGES | ||||||||
| APPLICATION NO: | PERIOD TO: | ||||||||
| APPLICATION DATE: | ARCHITECT'S PROJECT NO: | ||||||||
| A | B | C | D | E | F | G | H | I | |
| WORK | COMPLETED | MATERIALS | TOTAL | BALANCE | |||||
| ITEM | SCHEDULED | FROM PREVIOUS | THIS | PRESENTLY | COMPLETED | % | TO | RETAINAGE | |
| NO. | DESCRIPTION OF WORK | VALUE | APPLICATIONS | PERIOD | STORED | AND STORED | (G/C) | FINISH | |
| (D+E) | (NOT IN | TO DATE | (C-G) | ||||||
| D+E) | (D+E+F) | ||||||||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0% | 0.00 | 0.00 | ||
| TOTAL PAGE 1 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
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