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APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF TWO PAGES <br /> TO OWNER:CITY OF EVERETT APPLICATION NO:l Distribution to: <br /> 3200 CEDAR ST x OWNER <br /> EVERETT,WA 98201 n ENGINEER <br /> PERIOD TO: CONTRACTOR <br /> CONTRACTOR: <br /> MERRELL BROS.,INC. <br /> PROJECT NOS: UT 3752-1/20 <br /> 2021 BIOSOLIDS AND BACKWASH SOLIDS REMOVAL CONTRACT DATE:02.02.2021 <br /> CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br /> 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 <br /> Continuation Sheet,AIA Document G703,is attached completed in accordance with the Contract Documents,that all amounrs have been paid by <br /> the Contractor for Work for which previous Certificates for Payment were issued and <br /> payments received from the Owner,and that current payment shown herein is now due. <br /> MERRLL BROS.,INC. <br /> 1.ORIGINAL CONTRACT SUM $ 1,038,792.30 <br /> 2.Net change by Change Orders $ 0.00 CONTRACTORz) <br /> 3.CONTRACT SUM TO DATE(Line 1 4-2) $ 1 A3&79230 <br /> 4.TOTAL COMPLETED&STORED TO $ 765,909.77 Dustin Smith <br /> DATE (Column G on G703) By: Date: (//ll 12 l <br /> 5.RETAINAGE: <br /> a. 5 %of Completed Work $ $38,295.49 State of:Indiana County:Howard s„•,, ''t"'n,, <br /> (Column D+Eon G703) Subscribed and ,tQ bef t s t day of June 2021. ss, L0 RI J <br /> b. %of Stored Material $ Included in above Notary Public: (�'� Prince 1ptori Jqs �Jjp-tArY r. <br /> (Column F on G703) My Commission res:iiov r 21,2026 Residglit of Udnar Couri(+A t• t <br /> Total Retainage(Lines 5a+Sb or : as,t C. 4c�. , oe• CD <br /> Total in Column 1 of G703) $ 38,295.49 ARCHITECT'S CERTIFICATE FOR PAYMENT _ "ss Hof , �: z <br /> 6.TOTAL EARNED LESS RETAINAGE $ 727.61428 In accordance with the Contract 0.iuments.based on on.sitc obsenauons and the djyta-4 ,„ <br /> (line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of ME;?A',Gov • .n <br /> 7.LESS PREVIOUS CERTIFICATES FOR Architects knowledge.information and belief the Work has progressed as indicated. SC,• _ <br /> •;`+ Y,1� <br /> PAYMENT(Line 6 from prior Certificate) $ $0.00 the quality of the Work is in accordance with the Contract Documents,and the Contnctl OA,••e s?I-. >F <br /> ,•, <br /> &CURRENT PAYMENT DUE 4 727,614.28 I is entitled to payment of the AMOUNT CERTIFIED. ,/ND I AN?'„,`••s• <br /> 9.BALANCE TO FINISH,INCLUDING RETAINAGE $ 311,176.02 ''771 q„„„1Ln` <br /> (Line 31ess Line 6) AMOUNT CERtIFIBD $ <br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied Initial all figures on this <br /> Total changes approved Application and onthe Continuation Sheet that are changed no conform with the amount certified) <br /> in previous months by Owner ARCHITECT: <br /> Total approved this Month By: Date: <br /> TOTALS $0.00 $0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the <br /> Contractor named herein.Issuance,payment and acceptance of payment are without <br /> NET CHANGES by Change Order S0.00 prejudice to any rights of the Owner or Contractor under this Contract. <br /> ALA DOCUMENT G202•APPLICATION AND GENTIFCACON Foe PAYMENT-1992 EDITION•AN•e1992 THE AMERICAN INSTITUTE OP ARGNRECTS,1735 NEW YORE Ave..N.W.,WASHINGTON.DC 20p365292 <br />