WA9401-CS 950522 (3)APPLICATION AND CERTIFICATE
TO City of Coppell
P. O. Box 478
Coppell, TX 75019
FROM (CONTRACTOR): ARCHITECTURAL UTILITIES,
P. O. Box 11586
Fort Worth, TX 76110
CONTRACT FOR:
FOR PAYMENT AIA DOCUMENT G702
PROI[CT: East Beltline Road
Water Line Project
(WA 94-01 )
INC.
AUI Job # 94061
(Inslrucljons or~ reverse side) I'AGE ONF OF PAG[S
API~LICATION NO: 4 & Fi~1~L Distribulion to:
[_3 OWNER
PERIOD TO: 5/18/95 [] ARCHITECT
[] CONTRACTOR
ARCI-II'FI!C'r'S C]
I>ROJECr NO: []
CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT
CHANGE ORDER SUMMARY
Change Orclers approveEl in AL)Dlll ION5 I)LI)UC'I IONS
previous months by Owner
TO'!AL
Approved Ibis Monlh
Nunlber Dale Approved
TO'IALS
Nel change by Change Orders
The undersigned Conlractor CertifiLs Ihal to Ihe besl of Ihe CorHrac'h;r's knowh:dge,
iniormalion and belief Ihe Work covered by Ihis Applicalion Ior t'aymenl has been
completed in accordance wilh Ihe Conlracl Uocumenls, Ihal all amounls havt beeq
paid by the Conlraclor for Work for which previous Cerlilicales I'or I~aymenl were
issued ancl payments received from Ihe Owne,', and thai currenl i>ayment shown
herein is now due.
CONTRACTOR:
i)ate: 5/22/95
ARCHITECT'S CERTIFICATE FOR PAYMENT
In accordance wilh the Conlracl Documents, based on on-sile c~bservalions and Ihe
data comprising the above application, the ArChilect cerl ifies Io the Owner Ihal Ic.~ Ihe
besl ol Ihe Archilecl's knowledge, inlDrmalion anti beliel Ihe Work has progr~.:ss~d as
indicaled, Ihe quality ol Ihe Work is in accordance wilh Ihe Conlracl Documenls, and
Ihe Conlraclor is emilled Io paymenl ol II~e AMOUN[ CER'I IFIEI).
AIA DOCUMENT G702 · API'I ICAI II )N AND CLR1 IHCA'I F rt')R I'AY/~fl:N r · MAY 'lgll.I II III ll.)N · AIA' · ~;. pill I
TM~[ AMLRICAN INSII'IUil. C)F ARCHIll. C15, 1735 NEW YCIRK AV|.NUI, N.W., WASHIN(;I()N. I).C. 2(i(RR,
Al]plic:alion is made: h:~r Paymenl, as showr~ bdow, in connecliun wilh the Conlracl.
Continualion Sheel, AIA Ducumenl G703, is allached.
1. ORIGINAL CONTRACT SUM ....................... $ 133,976.54
2. Net change by Change Orders ..................... $
3. CONTRACT SUM TO DATE (I.ine I ~: 2) .............. $ 133,976 · 54
4. TOTAL COMPLETED & SIORED TO DATE ............ $ 130,462.75
(Cohmln G on G703)
5. RETAINAGE:
a. % U( Completed Work $ 0.00
(Column D + E on G703)'
1>. ____ % of Stored Material $
tColumn F on G703}
Tolal Relainage (Line 5a + 5b or
'[olal in Colun~n I of G703) ..................... $ 0.00
6. TOTAL EARNED LESS RETAINAGE ................... $ 130,462.75
(I. ine 4 less Line 5 Tolal)
7. LE55 PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prier Cerlificale) ......... $ 116,721.49
8. CURRENT PAYMENT DUE .......................... $ 13~741 .~6
9. BALANCE 10 FINISH, PLUS REIAINAGE ............. $ 0.00
(I.ine 3 less Line 6)
Mllach explan~ljon if alnounJ cerli~ed c~ffets from Ihe aalounJ applied for.)
ARCH ITECT:
By: __ Date:
This Cerlificale is nol negolialfi{;. The AMOUNT CERTIFIED is payable only Io the
Conlractor named lierein. Issuance, payrnenl and acceplance of paymenl are wilhoul
I~rejuclice to any rights of the Owner Dr Contractor under Ibis Conlracl.
G702-1983
0~
CI~ OF COppI~r.T.
P. O. BOX 478
COPPELL, fJ[~X 75019
PROJECT= EAST BELTLINE ROAD WATER MAIN
ORIGINAL CONTRACT COST: $133,976.54
PERIOOICAL ESTIMATE NO. 4 & FINAL
CO~I'RACTOR
ARCHITEC'IqIRAL UTILITIES, INC.
P. O. BOX 11586
FORT WORTH, ~X 76110
PERIOD 3/01/95 TO 5/18/95
AUI JOB NO. 94061
Quantity Quantity Quantity Quantity value of value of
original complete complete complete Work complete Work Complete
l~em Description Estimate UM Unit Price Prev.Mo. This Month To DaTa This Month To DaTa
=
:
1 Z 8' DR-14 WATER
2: 12" CL 150 W~TF.R
3 = 8" CA.TE VALVE
4 = R~CONNECT 2' SERVICE:
BO~E FOR 8' PIPE
AIR ~x.~ASE VALVE
2' BLOW OFF
4' FIRE HYDRANT
2" TEMP. WATER
2507: LF: $24.17: 2507: 0: 2507: $0.00: $60,594.19
1178: LF: $28.55: 1178: 0: 1178: $0.00: $33,631.90
7: EA: $448.00: 7: 0: 7: $0.00: $3,136.00
I: EA: $451.00: 0: 1: 1: $451.00: $451.00
236: LF: $121.67: 262: -23.76: 238.24: ($2,890.88)= $28,986.66
2: ER: $832.00: i: 0: 1: $0.00: $832.00
I: ER: $1,118.00: I: 0: I: $0.00 z $1,118.00
: : : : : : :
I: EA: $1,416.00: I: 0: I: $0.00: $1,416.00
500: LF: $6.60: 45: 0: 45: $0.00: $297.00
($2,439.88) $130,462.75
PERFORHED ON ORIGINAL CONTRACT
EXTRA WORE PERFORMED
TOTAL VALUE OF WORK TO DATE
LESS RETAINAGE - 10%
NET AMOUNT EARNED ON CONTRACT
LESS AMT OF PREVIOUS PAYMENTS
$130,462.75
$o.oo
$130,462.75
$0.oo
$130,462.75
$116,721.49
AMOUNT DUE THIS ESTIMATE $13,741.28