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SW0801-CN110307
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF 2 PAGES TO OWNER: PROJECT: Denton Tap Sidewalk Infill. APPLICATION #: 4 Distribution to: City of Coppell PERIOD TO: 02/28/11 255 Parkway PROJECT NOS: SW08 -01 X Owner Coppell, Tx. 75019 Const. Mgr FROM CONTRACTOR: VIA ARCHITECT: City of Coppell CONTRACT DATE: 11/08/10 Architect 3D Paving and Contracting LLC Contractor PO Box 1698 Coppell, Tx. 75019 \ ( CONTRACT FOR: 179 Cal. Days i:11t Days -'Days Remain II /0110 — /6/( I CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment. as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown therein is now due. 1. ORIGINAL CONTRACT SUM $ 231,754.00 CONTRACTOR: 2. Net change by Change Orders $ $ 22,732.44 3. CONTRACT SUM TO DATE (Line 1 +/_ 2) $ 254,486.44 By: fife Date: 3l 7, 4. TOTAL COMPLETED & STORED TO DATE -$ .125.,..92-6754 (Column G on Continuation Sheet) 7 ! ( ' 3 z a 5 ,� State of: 4) , s ,,,,„, 5. RETAINAGE: 17 S 3.Z. , 7 v County of: �� 4` MELONY 0 SCHASTEEN a. 10.0% of Completed Work $I �- Subscribed and sworn to befor- r � `, My Commission Expires (Columns D +E on Continuation Sheet) me this — I day of ( [1 . rail Gib 5 March 30. 2013 b. of Stored Material $ (Column F on Continuation Sheet) Notary Public: il ALIA / /%' .. 'IN/ 1 .4 Total Retainage (Line 5a + 5b or 7 S 32, SS My Commission expires: 30, d013 Total in Column 1 of Continuation Sheet $ 1-7_,-,592-:64' CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $8-:00 In accordance with Contract Documents, based on on -site observations and the data comprising (Line 4 less Line 5 Total) application, the Architect certifies to the Owner that to the best of the Architects knowledge, 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 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 AMOUNT CERTIFIED. (Line 6 from prior Certificate) $ 110,030.12' 8. CURRENT PAYMENT DUE $ 48730348- 9. BALANCE TO FINISH, INCLUDING RETAINAGE rl 1 7V-, :'''l AMOUNT CERTIFIED $ (Line 3 less Line 6) $ 967452-44 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this application and on the Continuation Sheet that are changed to conform to the amount certified.) CHANGE 6 e e - AI + Y , - Y ADDITIONS DEB. TIONS ARCHITECT: Total cha s approved in previous .N month y Owner By: Date: Total pproved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named TOTALS \ herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner of Contractor under this Contract NET C by Change Order SCHEDULE OF VALUES Company: 3D Paving and Contracting,LLC Project: ..,....... PO Box 1698 Application # 4 Coppell, Tx. 75019 Date: 2/28/2011 Period 1/28/2011 TO 2/28/2011 CONTRACT PREVIOUS QUANTITY TOTAL AMOUNT THIS EXTENDED ITEM DESCRIPTION OF WORK QUANTITY UNIT QUANTITY THIS PERIOD QUANTITY UNIT PRICE PERIOD AMOUNT o , r 1 Mobilization 1 LS 40% 20% 60% 510,000.00 $2,000.00 56,000.00 a 4" Thick Reinforced Concrete _ 1 • 2 Sidewalk 30725 SF 16150 6129 22279 $3.60 522,064.40 $§0,202.40 �� > 4" Thick Reinforced Concrete \--....- 3 Sidewalk in DART ROW 1335 SF 0 0 0 53.60 4" Thick Reinforced Concrete 4 Sidewalk in Atmos Gas ROW 290 SF 290 0 290 53.60 51,044.00 5 Reinforced Concrete Driveway 8560 SF 7241 1425 8866 $4.25 $6,056.25 $36,830.50 Reinforced Concrete Driveway with 6 Integral Color 310 SF 0 380 380 $6.00 _ 52,280.00 $2,280.00 Remove & Dispose of Concrete 7 Waste Material 9335 SF 7331 1805 9136 $1.00 51,805.00 $9.136.00 8 Barrier Free Ramp 6 EA 2 _ 2 4 5450.00 5900.00 51,800.00 Regrade & Adjust Existing 9 Landscaping at 580 S. Denton Tap 1 LS 1 0 _ 1 $1,200.00 $1,200.00 10 TxDOT PR1 Railing 70 LF 0 0 0 $100.00 11 Erosion Control 1 LS 0 1 1 $2,000.00 $2,000.00 $2,000.00 12 Traffic Control 1 LS 50% 25% 75% $5,000.00 $1,250.00 53,750.00 13 Retaining Wall- Stacked Block 770 SF 115 284 399 520.00 $5,680.00 $7 9 00 9 0 14 Reset Valve Stack to proper Height 7 EA 2 2 4 5150.00 5300.00 1,200.0 1 15 Relocate Water Meter Box 9 EA 9 2 11 5500.00 $1,000.00 $ , + Water Vault & Faucet © 890 S 16 Denton Tap 1 EA 0 1 1 $750.00 5750.00 5750.00 17 Railroad Pedestrian Signs _ 4 EA 0 0 0 5150.00 18 Sod 12000 SF 2000 5800 7800 50.50 — $2,900.00 53,900.00 19 Concrete Flume at Dairy Queen 1 LS 0 1 1 $950.00 $950.00 5950.00 20 Concrete Flume at 150 S. Denton Tap 1 LS 1 0 1 $950.00 5950.00 21 Modified Curb Inlet 1 EA 1 0 1 $2,800.00 S2,800.00 Remove & Replace Metal Beam 22 Guardrail 110 LF 0 55 55 545.00 $2,475.00 52,475.00 CO #1 Grading and Sod at 120S Denton Tap 1 LS 1 0 1 54,516.44 54,516.44 CO#2 0 522,716.00 CO #3 Flexbase Install at 794S Denton Tap 1 LS 0 1 1 $662.20 $662.20 $662.20 _ $53,072.85/ $175$2654 �� Total Amount Billed: $175,920.54 d /J_ Less Retainage: 10% $17,582:65 1753 Z mds n J Less Previous Applications 5110,030.12/ \ Net Amount Due This Application $487399 L I 7, 7c5.5.2