SS9402C-CS000102APPLICATION AND CERTIFICATION FOR PAYMENT AIADOCUMENTGT02
TO OWNER: City of Coppell PROJECT: Bethel Road Reconstrustion APPLICATION NO: One
255 Parkway
Coppell, Texas 75019.4409
FROM CONTRACTOR: VIA ARCHITECT:
Pavecon. Inc.
P. O. Box 535457
Grand Prairie, TX 75053
CONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract.
Continuation Sheet, AIA Document 0703, is attached.
PAGE 1 OF 2
PERIOD TO: January 31,2000
PROJECT NOS: 9916095
Distribution to:
[-~ OWNER
[~-]ARCHITECT
[--~CONTKACTOR
CONTRACT DATE: November 24,1999
The undersigned Contractor certifies that to the best of the Contractoffs knowledge,
information and balief the Work covered by this Application for Payment has been
completed in accordance with the 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 herein is now due.
I. ORIGINAL CONTRACT SUM
2. Net change by Change Orders
3. CONTRACT SUM TO DATE (Line 1 ± 2)
4. TOTAL COMPLETED & STORED TO
DATE (Cohinm G on 0703)
5. KETAINAGE:
a. 10% of Completed Work $ $8,970.47
(Column D + E on 0703)
b. % of Stored Material $ 0
(Column F on 0703)
Total Retoinage (Lines 5a + 5b or
Total in Column I of 0703)
6. TOTAL EARNED LESS RETAINAGE
(Lir~ 4 Less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Certificate)
8. CURP,~NT PAYMENT DUE
9. BALANCETO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$ 221,509.02
$ 0.00
$ 221,509.02
$ 89,704.65
$ 8,970.47
$ 80,734.19
$ $0.00
$ 80,734.19
$ 140,774.84
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved
in previous months by Owner $0.00 $0.00
Total approved this Month
TOTALS $0.00 $0.00
NET CHANGES by Change Order $0.00
CONTRACTOR:
By: ' -, (J Date: /
8tateo .'.'5 0/V0 g ,., Court, or t q .....
Subscfib.~s~lobfforemethis I~ dayof ~~~~
ARCHITECT S CERTIFICATE FOR
~ acco~ce ~th the Con~t Doc~eats, b~ on on-site obs~a~o~
co~dsi~ the ~plicatioa, the A~tect ce~s ~ th~ O~n~r ~t to ~e best of the
~c~tecfs ~owl~ge, info~tion ~d belief ~e Work ~ pm~ss~ ~ i~t~t~,
the quali~ of the Work is in accor~ce with the Coatmct ~cumen~, ~d the Con~ctor
is entitl~ to pa~ent of the AMO~ CERTW~D.
AMOUNT CERTIFIED ........... $
(Attach explanation {f amount certified differs from the amount applied. Initial all figures on this
Application and onthe Continuation Sheet that are changed to conform with the amount certified.)
ARCHrrECT:
By: Date:
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named hereto. Issuance, payment and acceptance ct payment are without
prejudice to any fights of the Owner or Contractor under this Contract.
Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee.
CONTINUATION SHEET DOCUMENTG703 .^oe2or2com
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: One
Contractor's signed certification is attached. 9916095 APPLICATION DATE: 3anuar¥ 32~, 2 0 0 0
In tabulations below, amounts are stated to the nearest dollar. Bethel Road PERIOD TO: January 3 1,2 0 0 0
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
A B C D [ E F G H I
iTEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G + C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORED (C - G) RATE)
(D + E) (NOT IN TO DATE
D OR E) (D+E+F)
l Remove Existing Material $41,742.48 $30,807.40 $30,807.40 73.80% $10,935.08
14,722 SY ~ 8.84 =)
2 ?abric $4,769.22 $4,040.00 $4,040.00 84.71°/ $729.22
I(4,722 SY~ $l.01 =)
3 Recompact the Material $74,371.50 $54,857.25 $54,857.25 73.76~ $19,514.25
(4,722 SY ~ $15.75 =)
4 Imported fill (Select Fill)
(~ $15.00 per CY Truck Measure)
5 Flowable Fill as Directed
(~ $150.00 CY)
6 2" HMAC $24,884.94 $24,884.94
(4,722 SY ~ $5.27/SY)
7 Recycle existing base w/c~ment $75,740.88 $75,740.88
(4,722 SY ~ $16.04 SY)
GRAND TOTALS $221,509.02 $0.00 $89,704.65 $0.00 $89,704.65 40.50% $131,804.37 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - CertiflcaUon of D~cument's Authenticity
AIADOCUMENTG703 CONTINUATIONSHEETFORG702 1992EDITION AIA 01992
BETHEL ROAD
01/31/2000
THIS THIS THIS
BID BID BID BID MONTH MONTH MONTH
ITEM DISCRIPTION BID UNIT UNIT AMOUNT QUANTITY UNIT AMOUNT
QUANTITY PRICE
I EXCAVATION 4,722 SY $ 8.84$ 41,742.48 3,485 SY $ 30,807.40
2 FABRIC 4,722 SY $ 1.01$ 4,769.22 4,000 SY $ 4,040.00
3 RECOMPACT FILL 4,722 SY $ 15.75 $ 74,371.50 3,483 SY $ 54,857.25
4 IMPORTED SELECT FILL CY TRUCK $ 15.00
5 FLOWABLE FILL CY $ 150.00
6 2" HMAC 4,722 SY $ 5.27 $ 24,884.94
7 RECYCLE BASE 4,722 SY $ 16.04 $ 75,740.88
$ 221,509.02 $ 89,704.65
TO DATE TO DATE TO DATE
QUANTITY UNIT AMOUNT
3,485 SY $ 30,807.40
4,000 SY $ 4,040.00
3,483 SY $ 54,857.25
$ 89,704.65