WA9401-CS 950522 (2)APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instruclions on reverse side) ,'AGE ONFOI~ P^Gt:S
TO C~ty of Coppell I'ROIECT: ~ast Boltline Road APPLICA[ION NO: 4 & FIN~ Distribution to:
P. O. Box 478 Water Line Project [3 OWNER
Coppell, TX 75019 (T~A 94-01 ) PERIOD TO: 5/18/95 [:]ARCHITECT
[] CONTRACTOR
FROM (CONTRACTOR): ~CHI'I']L"Td]~ U~ILITIES, INC. ARCHITEC['S
P. O. Box 11586 I'I(OIEC[ NO: []
Forl= Worth, ~X 76110 AUI Job # 94061
CONTRACT FOR: CONTRACT [)ATE:
CONTRACTOR'S APPLICATION FOR PAYMENT
CHANGE ORDER SUMMARY
Change Orders approved in
previous rnonlhs by Owner
TO1AL
Approved this Monlh
Number Dale Approvecl
ADDI'I IONS I)LI)UC'I IONS
TO'IAL5
Nel chanBe by Change Orders
The undersiEned Conlraclor certi(ics Ihal Io the besl o1' Ihc Ccmlrac h~r's knowledge,
iniormalion and belie[ Ihe Work cavered by Ihis Applicalicm for I'aymenl has heen
compleled in accordance wilh Ihe Conlracl Dix:u~nenls, Ihal all :.nounis have been
paid by the Conlraclor (or Work for whicl~ i~revious CerliJicales Lot I~aynR,nl were
issued ancl paynlcnls receiv¢:d from Ihe Owner, aud Ihal ct, trenl ixWmenl shown
herein is now due.
CONTRACTOR:
Dj, le:
5/22/95
ARCHITECT'S CERTIFICATE FOR PAYMENT
In accordance wilh the Conlracl Documents, based on on-site c~bservaliuns alld the
dala comprising Ihe above applicalion, Ihe Archilecl cerlifies Io Ihe Owner Ihal Io Ihe
besl ol Ihe Arcbilecl's knowledge, inforn~alion and belie[ the Work has progressed as
indicated, Ihe qualily o[ Ihe Work is in accordance wilh Ihe Conlracl Documenls, and
~e Conlractor is enlilled Io paymeal o[ Ihe AMOUNI' CER'I IFIED.
Ai}l~lic:alion is made for Paymenl, as shnwn below, in conneclion wilh Ihe Conlracl.
Continualion Sl~eel, AIA Dgcumenl G703, is allached.
1. ORIGINAL CONTRACT SUM ....................... $ 133,976.54
2. Nel change by Change Orders ..................... $
3. CONTRACT SUM TO DATE (I.ine I ~: 2) .............. $ 133,976.54
4. TOTAL COMPLETED & STORED TO DATE ............ $ 130,462.75
(Column G on G703)
5. RETAINAGE:
a. % of Completed Work $ 0.00
(Column D + E on G703)
b. __ % o[ Stored Material $
(Colunto F on G703)
Total R~:lainage (I. ine 5a + 5b or
lolal in Ccfiumn I of G703) ..................... $ 0.00
6. TOTAL EARNED LESS RETAINAGE ................... $ 130,462.75
(I.ine 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Cerlificale) ......... $ 116,721.49
8. CURRENT PAYMENT DUE .......................... $ 13r741.26
9. BALANCE TO FINISH, PLUS RETAINAGE ............. $ 0.00
(I.ine 3 less Line 6)
51ale o(: ~ · _~ .:.,~'...~ Counly ol: TARRA~,. !
ARCI4 ITFCT:
IJy: Dale:
This Cerlific:ale is nol negoliahh;. The AMOUNT CERTIFIED is payable only Io Ihe
Conlraclor named herein. Issuance, payment and acceplance o[ paymenl are wilhoul
prejudice Io any rights of the Owner or Conlraclor under Ihis Conlracl.
AIA DOCUMENI G702 · Al'lq ICAI II)N AND CIRI lI ICA'IF FOR I'AY~,II:NI' · MAY I¢111.1 IIII II(.)N · AIA' · ~;.
THE. AMLRICAN INS1HUII. C)l' ARCHIII.CIS, 1715 NEW YCIRK AV[NUI. N.W., WASIIIN(H(.IN. I).C. 21Rlllh G702-1983
CITY OF COPPELL
P. O. BOX 478
COPP~LL, TX 75019
PI%CXTECT: FaaT BELTLINE ROAD WATER MAIN
ORIGINAL CONTRACT COST: $133,976.54
PERIODICAL ESTIMATE NO. 4 & FINAL
CONTRACTOR
ARCHIT~CTUP~L UTILITIES, INC.
P. O. BOX 11586
FOI~ WOETH, ~X 76110
PERIOD 3/01/95 TO 5/18/95
AUI JOB NO. 94061
Quantity Quantity Quantity Quantity value of value of
original complete completa Complete Work Complete Work Completa
Item Description Estimate UM Unit Price Prev.Mo. This Month To Date TLls Month To Date
8w DR-14WATER = 2507 z LF: $24.17 s 2507 = 0: 2507: $0.00: $60,594.19
12" CL 150 WATER : 1178: LF: $28.55: 1178: 0: 1178: $0.00: $33,631.90
8" GATE VALVE : 7: EA= $448.00: 7: 0: 7: $0.00: $3,136.00
REODNNECT 2" SERVICE: I: EAT $451.00: 0: I: I: $451.00: $451.00
BO~ FOR 8" PIPE : 236 ~ LFS $121.67: 262: -23.76: 238.24: ($2,890.88)~ $28,986.66
AIR F~T.nASE VALVE : 2: BA: $832.00: I: 0; I I $0.00: $832.00
2" BLOW OFF : I: EA: $1,118.00: I: Q: I: $0.00: $1,118.00
4' FIl~8 BYDRAIqT : 1 = EA: $1,416.00 ~ I ~ 0: 1: $0.00: $1,416.00
2e TEMP. WA"ZgP, ; 500; LF: $6.60: 45: 0 = 45 I $0.00: $297.00
($2,439.88) $130,462.75
PERFORMED O!( ORIGINAL CORTR~'E
EXTRA WORK P~RFORMED
TOTAL VALUE OF WORK TO DATE
LE~8 RETAINAGE - 10%
ITETAMOUNTFa~RNEDOBCO~TRACT
LESS AMT OF PREVIOUS PAYMENTS
$130,462.75
$o.oo
$130,462.75
$o.oo
$130,462.75
$116,~21.49
AMOUNT DUE' TBIS ESTIMATE
$13,741.26