Sample_Pay_Application_G702-G703.pdf
PDF 266 KB Posted
- Attached to
- ITB 26-196 Southwest Regional Water Reclamation Facility (SWRWRF) - Reclaimed Water System
- Solicitation number
- ITB 26-196
- Issued by
- Citrus County, Florida
About this file
This is a Payment Application (AIA Document G702-G703) submitted by a contractor to Citrus County, Florida's Water Resources Department for the Southwest Regional Water Reclamation Facility (SWRWRF) Reclaimed Water System project located at 3600 W Sovereign Path, Lecanto, Florida. The project involves construction of approximately 22,000 feet of transmission mains, a 1.0 million gallons per day ground storage tank, a high-service pump station, a booster pump station, and associated appurtenances to supply reclaimed water to Sugarmill Woods and Citrus National Golf Courses. The original contract sum is $1,427,109.71 with no approved change orders to date. The payment application documents work completed and materials supplied through the period ending on the application date, with a schedule of values detailing thirty-two line items ranging from mobilization and demolition to electrical and instrumentation work, landscaping, and contingency allowances.
The current payment application shows zero dollars certified for payment, indicating no work progress has been completed or certified by the engineer at the time of this application. Total retainage is set at five percent of both completed work and stored materials. The application includes documentation of stored materials valued at $390,714.94, consisting primarily of odor control systems and pumps for lift stations CG-01, CG-02, CG-03, and GS-02, GS-03, with materials delivered by vendors such as Core & Main between September and December 2023. The balance to finish, including retainage, remains at the full contract amount of $1,427,109.71, indicating the project is in its early stages. The contractor certifies compliance with all federal, state, and local tax and employment laws in connection with contract performance.
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APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702
TO (OWNER):Citrus County, Water Resourc PROJECT NAME: PAY APPLICATION #:
3600 W Sovereign Path, # 291 CIP #: APPLICATION DATE:
Lecanto, FL 34461 VIA ENGINEER: PERIOD START:
PROJ MGR: ENG'S PROJECT #: PERIOD ENDING:
FROM (CONTRACTOR): BOCC Payment Data:
Distribution to: ITB #
OWNER X PO #
ENGINEER X
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract.
Continuation Sheet, AIA Document G703, is attached.
1. ORIGINAL CONTRACT SUM $ 1,427,109.71
2. Net change by Change Orders (BOCC Appr'd) $ 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 ± 2) $ 1,427,109.71
4. TOTAL COMPLETED & STORED TO $ 0.00 By: Date:
DATE (Column G on G703)
5. RETAINAGE: State of: County of:
a. 5 % of Completed Work $ 0.00 Subscribed and sworn to before me this day of (Column I + J on G703) Notary Public:
b. 5 % of Stored Material $ 0.00 My Commission expires:
(Column K on G703) ENGINEER'S CERTIFICATE FOR PAYMENT:
Total Retainage (Lines 5a + 5b or Total in Column O of G703) $ 0.00
6. TOTAL EARNED LESS RETAINAGE $ 0.00
(Line 4 Less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Certificate) $ 0.00 AMOUNT CERTIFIED . . . . . . . . . . . $
8. CURRENT PAYMENT DUE $ 0.00
9. BALANCE TO FINISH, INCLUDING RETAINAGE $ 1,427,109.71
(Line 3 less Line 6) Project Manager:
By: Date:
CONTRACT CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved ENGINEER:
in previous months by Owner $0.00 $0.00 By: Date:
Total approved this Month $0.00 $0.00 Title:
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.
I hereby certify that the work performed and the materials supplied to date, as shown above, represent the actual value of accomplishment under the terms of the Contract (and all authorized changes thereto) between the undersigned and Citrus County BOCC relating to the above referenced project. I also certify that payments, less applicable retainage, have been made through the period covered by the previous payments received by the contractor, to: all subcontractors;
for all materials and; for all labor used on or in connections with the performance of the Contract. I further certify I have complied with Federal, State and local tax laws, including Social Security, Unemployment Compensation, and Worker's Compensation laws insofar as applicable to the performance of the contract.
In accordance with the Contract documents based on site observations and the data comprising this application, the Engineer certifies to the Owner that to the best of the Engineer's knowledge, information and belief the Work has been performed as indicated, the quality of the Work is in accordance with the Contract Documents and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
(Attach explanation if amount certified differs from the amount applied for, Initial all figures on this Application and on Continuation Sheet(s) that are changed to conform to the amount certified.)
PAY APPLICATION CONTINUATION SHEET AIA DOCUMENT G703
PROJ: 0 PAY APPLICATION #: 0
CITRUS COUNTY, FLORIDA APPLICATION DATE: 01/00/1900
SCHEDULE OF VALUES PERIOD ENDING: 01/00/1900
Contractor's signed certification is attached. PO # 0
A B C D E F G G2 H K L M N O
STORED MATERIALS 5%
UNIT CAA # 1 CAA # 2 % VALUE % VALUE TOTAL COST
COMPLETE COMPLETE COMPLETE COMPLETE REMAINING STORED (I+J+K)
1 Mobilization 1 LS $59,810.00 59,810.00 59,810.00$ -$ -$ -$ 0% 59,810.00$ -$ 2 Construction Staking/As-Built 1 LS $19,920.00 19,920.00 19,920.00$ -$ -$ -$ 0% 19,920.00$ -$ 3 Demolition 1 LS $106,570.00 106,570.00 106,570.00$ -$ -$ -$ 0% 106,570.00$ -$ 4 Pressure Testing 1 LS $11,560.00 11,560.00 11,560.00$ -$ -$ -$ 0% 11,560.00$ -$ 5 Density Testing 1 LS $9,620.00 9,620.00 9,620.00$ -$ -$ -$ 0% 9,620.00$ -$ 6 Erosion Control/Silt Fence 200 LF $6.40 1,280.00 1,280.00$ -$ -$ -$ 0% 1,280.00$ -$ 7 Open Cut & Repair Driveway 192 SY $15.00 2,880.00 2,880.00$ -$ -$ -$ 0% 2,880.00$ -$ 8 8" SDR 35 PVC Gravity Sewer 9 LF $1,680.00 15,120.00 15,120.00$ -$ -$ -$ 0% 15,120.00$ -$ 9 4" 316 Stainless Steel Piping 20 LF $1,255.70 25,114.00 25,114.00$ -$ -$ -$ 0% 25,114.00$ -$
10 4" P401 Lined Ductile Iron Piping 15 LF $4,762.40 71,436.00 71,436.00$ -$ -$ -$ 0% 71,436.00$ -$ 11 4" DR18 C900 PVC Piping 745 LF $66.50 49,542.50 49,542.50$ -$ -$ -$ 0% 49,542.50$ -$ 12 4" Fittings 1 LS $15,620.00 15,620.00 15,620.00$ -$ -$ -$ 0% 15,620.00$ -$ 13 1" HDPE Water Service 565 LF $61.20 34,578.00 34,578.00$ -$ -$ -$ 0% 34,578.00$ -$ 14 Polymer Concrete Wetwell 1 EA $290,460.00 290,460.00 290,460.00$ -$ -$ -$ 0% 290,460.00$ -$ 15 Precast Concrete Valve Vault 1 EA $22,670.00 22,670.00 22,670.00$ -$ -$ -$ 0% 22,670.00$ -$ 16 Aluminum Hatches Flood Tight 2 EA $6,240.00 12,480.00 12,480.00$ -$ -$ -$ 0% 12,480.00$ -$ 17 Wetwell Safety Grating 1 EA $2,990.00 2,990.00 2,990.00$ -$ -$ -$ 0% 2,990.00$ -$ 18 Submersible Pumps, Rails, Elbow 2 EA $36,730.00 73,460.00 73,460.00$ -$ -$ -$ 0% 73,460.00$ -$ 19 Control Panel 1 LS $46,480.00 46,480.00 46,480.00$ -$ -$ -$ 0% 46,480.00$ -$ 20 Electrical & Instrumentation 1 LS $74,880.00 74,880.00 74,880.00$ -$ -$ -$ 0% 74,880.00$ -$ 21 4" Check Valve 2 EA $2,430.00 4,860.00 4,860.00$ -$ -$ -$ 0% 4,860.00$ -$ 22 4" Gate Valve w/NRS Handwheel 3 EA $1,870.00 5,610.00 5,610.00$ -$ -$ -$ 0% 5,610.00$ -$ 23 4" Gate Valve w/NRS 1 EA $2,760.00 2,760.00 2,760.00$ -$ -$ -$ 0% 2,760.00$ -$ 24 4" S.S. Pressure Gauge Assembly 2 EA $850.00 1,700.00 1,700.00$ -$ -$ -$ 0% 1,700.00$ -$ 25 Chain Link Fencing 1 LS $8,910.00 8,910.00 8,910.00$ -$ -$ -$ 0% 8,910.00$ -$ 26 Landscaping 1 LS $18,570.00 18,570.00 18,570.00$ -$ -$ -$ 0% 18,570.00$ -$ 27 Earthwork 4,873 CY $47.20 230,005.60 230,005.60$ -$ -$ -$ 0% 230,005.60$ -$ 28 Restoration - Bahia Sod 3,000 SY $11.40 34,200.00 34,200.00$ -$ -$ -$ 0% 34,200.00$ -$ 29 Pressure Grouting 1 CY $4,280.00 4,280.00 4,280.00$ -$ -$ -$ 0% 4,280.00$ -$ 30 Payment and Performance Bond 1 LS $16,690.00 16,690.00 16,690.00$ -$ -$ -$ 0% 16,690.00$ -$ 31 Maintenance of Traffic 1 LS $13,180.00 13,180.00 13,180.00$ -$ -$ -$ 0% 13,180.00$ -$
CONTINGENCY - INCLUDE VALUE IN BASE BID 1 LS $128,723.61 128,723.61 128,723.61$ -$ -$ -$ 0% 128,723.61$ -$
32 Gopher Tortoise Relocation (if required) 1 EA $11,150.00 11,150.00 11,150.00$ -$ -$ -$ 0% 11,150.00$ -$
CAA 1 -$ -$ -$ -$ -$
CAA 2 -$ -$ -$ -$ -$
CAA 3 -$ -$ -$ -$ -$
GRAND TOTALS 1,427,109.71$ -$ -$ 1,427,109.71$ -$ -$ -$ -$ 0.00% 1,427,109.71$ -$
ITEM
PREVIOUS PERIOD
UNIT COST /
PRICE
CAA'S & UPDATED SOV WORK COMPLETED
BALANCE TO
FINISH RETAINAGEQTY
COMPLETE
D
THIS PERIOD SEE ATTACHED
SUMMARY
COMPLETED
& STORED
CONTRACT
J
DESCRIPTION OF ITEMS / WORK TOTAL - SCHEDULED
VALUE
REVISED
SCHEDULED VALUE
I
PAY APPLICATION #: 0
PROJ: 0 APPLICATION DATE: 01/00/1900
CITRUS COUNTY, FLORIDA PERIOD ENDING: 01/00/1900
CIP # 0 PO # 0
Invoice # Inv Line #
G703 Item # Materials Description Qty
Delivered Unit Price
$ Date / PA # Qty $ Amount Qty $ Amount Date / PA # Qty $ Amount Qty $ Amount Qty $ Amount
JH111723 1 2.05 Lift Station - CG-01 Odor Control Sys 1 111,141.00 11/30/2023 1 $111,141.00 $0.00 $0.00 $0.00 1 $111,141.00 JH111723 2 2.06 Lift Station - CG-02 Odor Control Sys 1 111,141.00 11/30/2023 1 $111,141.00 $0.00 $0.00 $0.00 1 $111,141.00 JH111723 3 2.07 Lift Station - CG-03 Odor Control Sys 1 100,170.00 11/30/2023 1 $100,170.00 $0.00 $0.00 $0.00 1 $100,170.00 3556D03691 1 2.02 Lift Station GS-02 Pumps 1 46,143.92 12/31/2023 1 $46,143.92 $0.00 $0.00 $0.00 1 $46,143.92 3556D03691 2 2.03 Lift Station GS-03 Pumps 1 22,119.02 12/31/2023 1 $22,119.02 $0.00 $0.00 $0.00 1 $22,119.02
$0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00
TOTALS $390,714.94 $0.00 $0.00 $0.00 $390,714.94
Stored Previously Stored this Period
Stored Materials Summary Sheet
USE IF ONLY ONE PIECE OF MATERIAL PER G703 LINE ITEM #
Remaining StoredInvoice Data Incorporated Previously Incorp'd this Period
Remove sample data before using, just provided for direction PAY APPLICATION #: 0
USE IF MULTIPLE MATERIALS PER G703 LINE ITEM # APPLICATION DATE: 01/00/1900
0 0 PERIOD ENDING: 01/00/1900
CITRUS COUNTY, FL 0 PO #
A B C D E F G H I J K L M N O P A
G703 Item # DESCRIPTION OF MATERIAL VENDOR INVOICE
NUMBER
Inv Line Item
DATE UNIT OF
MEASURE
QUAN DEL'D PREV
PERIOD
QUANTITY DELIVERED
THIS PERIOD $ amt added
TOTAL QUANTITY
DELIVERED TO
DATE
QUAN INST'D
PREV PERIODS
QUANTITY
INSTALLED THIS
PERIOD
$ amt reduction
TOTAL QUANTITY
INSTALLED TO
DATE
STORED
MATERIAL END
OF THIS PERIOD
UNIT
PRICE
(invoice) Tax 6%
Total Price per
Unit
VALUE OF
MATERIALS
PAY
ITEM
NO.
2.05 Lift Station - CG-01 Odor Control System - 6% 2.05
2.05 SPEARS 1829-020 2IN IND TRUE U Core & Main U072164 1 12/18/2023 EA 60 8,665.80 60 - - 60 136.25 8.175000 144.43 8,665.80 2.05
2.05 T3SS-0360-021EX-HT316V 3X2 MIP Core & Main U062359 2 12/18/2023 EA 35 16,758.70 35 - - 35 451.72 27.103200 478.82 16,758.70 2.05
2.05 T3SS-0513-2021EX-HT316 4X2 MIP Core & Main U062359 3 12/18/2023 EA 6 2,929.92 6 - - 6 460.68 27.640800 488.32 2,929.92 2.05
2.05 2" FLAPPER CHECK VALVE Core & Main T782651 5 12/7/2023 EA 54 2,540.70 54 - - 54 44.39 2.663400 47.05 2,540.70 2.05
2.05 Totals 30,895.12 - - - 30,895.12 2.05
2.06 Lift Station - CG-02 Odor Control System - - 2.06
2.06 SPEARS 1829-020 2IN IND TRUE U Core & Main U072164 1 12/18/2023 EA 34 4,910.62 34 - - 34 136.25 8.175000 144.43 4,910.62 2.06
2.06 T3SS-0360-021EX-HT316V 3X2 MIP Core & Main U062359 2 12/18/2023 EA 23 11,012.86 23 - - 23 451.72 27.103200 478.82 11,012.86 2.06
2.06 T3SS-0513-2021EX-HT316 4X2 MIP Core & Main U062359 3 12/18/2023 EA 5 2,441.60 5 - - 5 460.68 27.640800 488.32 2,441.60 2.06
2.06 2" FLAPPER CHECK VALVE Core & Main T782651 5 12/7/2023 EA 68 3,199.40 68 - - 68 44.39 2.663400 47.05 3,199.40 2.06
2.06 461-S VALVE BOX COMPLETE 190 Core & Main T782651 20 12/7/2023 EA 39 3,307.20 39 - - 39 80.00 4.800000 84.80 3,307.20 2.06
2.06 2 F6103 THRD RW GV OL ON CLOW 170 Core & Main T782651 24 12/7/2023 EA 38 16,994.36 38 - - 38 421.91 25.314600 447.22 16,994.36 2.06
2.06 DFW1730C-18-1 17X30X18 BLK MTR BOX 290 Core & Main T782651 31 12/7/2023 EA 4 1,117.56 4 - - 4 263.58 15.814800 279.39 1,117.56 2.06
2.06 T444-777NL 2 TEE PJ (CTS) Core & Main T782651 40 12/7/2023 EA 20 7,003.60 20 - - 20 330.36 19.821600 350.18 7,003.60 2.06
2.06 3 F6100 MJ RW GV OL ON L/ACC CLOW GATE VA Core & Main T782651 26 12/7/2023 EA 3 1,999.05 3 - - 3 628.63 37.717800 666.35 1,999.05 2.06
2.06 2 TEE PJCXPJC NO LEAD 74760-22 Fortiline 6240823 2 9/29/2023 EA 7 - 7 1 5 (2,088.20) 6 1 394.00 23.640000 417.64 417.64 2.06
2.06 - - - - - - - - 2.06
2.06 Totals 51,986.25 (2,088.20) - - 52,403.89 2.06
2.07 Lift Station - CG-03 Odor Control System - - - - - - - 2.07
2.07 SPEARS 1829-020 2IN IND TRUE U Core & Main U072164 1 12/18/2023 EA 49 7,077.07 49 - - 49 136.25 8.175000 144.43 7,077.07 2.07
2.07 T3SS-0360-021EX-HT316V 3X2 MIP Core & Main U062359 2 12/18/2023 EA 18 8,618.76 18 - - 18 451.72 27.103200 478.82 8,618.76 2.07
2.07 T3SS-0513-2021EX-HT316 4X2 MIP Core & Main U062359 3 12/18/2023 EA 2 976.64 2 - - 2 460.68 27.640800 488.32 976.64 2.07
2.07 2" FLAPPER CHECK VALVE Core & Main T782651 5 12/7/2023 EA 19 893.95 19 - - 19 44.39 2.663400 47.05 893.95 2.07
2.07 461-S VALVE BOX COMPLETE (various) Core & Main T782651 20,21,22,23 12/7/2023 EA 25 2,120.00 25 - - 25 80.00 4.800000 84.80 2,120.00 2.07
2.07 2 F6103 THRD RW GV OL ON CLOW 170 Core & Main T782651 24 12/7/2023 EA 23 10,286.06 23 - - 23 421.91 25.314600 447.22 10,286.06 2.07
2.07 DFW1730C-18-1 17X30X18 BLK MTR BOX 290 Core & Main T782651 31 12/7/2023 EA 2 558.78 2 - - 2 263.58 15.814800 279.39 558.78 2.07
2.07 3 F6100 MJ RW GV OL ON L/ACC CLOW GATE VA Core & Main T782651 26 12/7/2023 EA 1 666.35 1 - - 1 628.63 37.717800 666.35 666.35 2.07
2.07 Totals 31,197.61 - - - 31,197.61 2.07
- 114,496.62
TOTAL ADDED 114,078.98 (2,088.20) TOTAL INSTALLED
NET ADJUSTMENT 111,990.78
Columns O & P Rounded to 2 digits
Stored Materials Summary Sheet
| G702_Sample Pay App.pdf |
| G703_Sample Pay App.pdf |
| Sample Pay App3.pdf |
| Sample Pay App4.pdf |
File details come from the government source that posted it. Updated .