ITB202608_CDBG_Infrastructure_Improvement_Project__Exhibit_N.pdf
PDF 86 KB Posted
- Attached to
- Infrastructure Improvement Project
- Solicitation number
- ITB-2026-08 CDBG
- Issued by
- Santa Rosa County, Florida
About this file
This is an Application and Certificate for Payment document (AIA Form G702) related to the City of Milton, Florida's ITB-2026-08 CDBG Infrastructure Improvement Project. The document serves as a contractor's application for payment submission and the corresponding certification by the construction manager. A mandatory pre-bid conference meeting and site visit was scheduled for 11:00 A.M. on Tuesday, July 21, 2026, at the City of Milton Council Chambers located at 6738 Dixon Street, Milton, FL 32570. The City of Milton solicited sealed bids for the CDBG-funded infrastructure improvement project in 2026.
The payment certificate form includes provisions for tracking the original contract sum, net changes by change orders, total contract sum to date, completed work and stored materials, and retainage at 10 percent of both completed work and stored materials. The document contains line items for calculating the amount currently due to the contractor, balance remaining to finish the project including retainage, and a change order summary tracking additions and deductions approved in previous months and the current month. All financial figures on the submitted template appear as $0.00, indicating this is a blank form template. The certificate requires certification by both the contractor and the construction manager that work has been completed in accordance with contract documents and that the contractor is entitled to the certified payment amount.
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Text version
APPLICATION AND CERTIFICATE FOR PAYMENT
DOCUMENT G702
Application No: Distribution To:
Period To: Owner yes/no
Contract For: Architect yes/no
Contract Date: Contractor yes/no
Project Nos: Field yes/no
Other yes/no
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in accordance with the Contract.
Continuation Sheet, Document G703, is attached.
1. Original Contract Sum
2. Net Change By Change Orders CONTRACTOR:
3. Contract Sum to Date (Line 1+2) By: __________________________________________ Date: ___________
4. Total complete & Stored To Date (Column G on G703)
5. Retainage State of:________________________________ County of : _______________
a. 10.00% of Completed Work Subscribed and sworn to before me this day of 25
(Column D + E on G703) Notary Public:
b. 10.00% of Stored Material My Commission Expires:
(Column F on G703)
Total Retainage (Lines 5a + 5b, or Total In Column 1 of G703)
6. Total Earned Less Retainage
(Line 4 less Line 5 Total)
7. Less Previous Certificates For Payment
(Line 6 from prior Certificate) AMOUNT CERTIFIED.
8. Current Payment Due
$0.00
To Owner: Project:
From Contractor: Via Architect:
The undersigned Contractor certifies that to the best of the Contractor's knowledge, 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 completed in accordance with the Contract Documents, that all amounts have been and payments received from the Owner, and that current payment shown herein is now due.
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CERTIFICATE FOR PAYMENT
$0.00
In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the
Construction Manager certifies that to the best of his knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the
Contractor is entitled to payment of the
$0.00
$0.00
9. Balance To Finish, Including Retainage AMOUNT CERTIFIED $0.00
(Line 3 less Line 6) $0.00
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in previous months by Owner $0.00 $0.00 By: __________________________________________ Date: ___________
Total Approved this Month $0.00 $0.00
TOTAL $0.00 $0.00
NET CHANGES by Change Order $0.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that changed to conform to the amount certified.).
This certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.
File details come from the government source that posted it. Updated .