ADOA_Exhibit_H_-_Application_for_Payment_ADOA.xlsx

This is an Application for Payment form (Exhibit H) developed by the Arizona Department of Administration (ADOA) for use in state and local construction contracts, specifically associated with the St. Johns Shooting Range Water Retention Project for the Arizona Game and Fish Department. The form serves as the contractor's submittal for payment and the architect/engineer's certificate for payment, allowing contractors to request reimbursement for completed work, stored materials, and approved change orders. The document is structured to track contract values from project inception through completion, with line items for original contract sum, change orders, completed work, retainage, and previous payments. The form requires certification by both the contractor and the architect/engineer that work has been completed in accordance with contract documents and that all previous payments have been received.

The payment application form establishes a 10 percent retainage rate on completed work and includes sections for tracking the balance to finish the project. Key calculated fields include the contract sum to date, total completed and stored materials, earned amounts less retainage, current payment due, and remaining balance. The form requires contractor and architect/engineer signatures with dates, notarization of the contractor's submittal, and a continuation sheet detailing the schedule of contract values broken down by line item with columns for work completed in previous periods, work completed in the current period, materials stored, total completion percentage, and remaining balance to finish. This standardized ADOA form, revised February 6, 2019, ensures uniform payment processing across state and local construction projects in Arizona.