Filetype Excel XLS | Posted on 05 Jul 2022 | 3 years ago
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731x Filetype XLS File size 0.05 MB Source: gcgbuilds.com
Sheet 1: AIA
| AIA DOCUMENT G702 | PAGE 1 OF 2 | ||||||||||||
| TO GC: | GCG Construction, Inc. | PROJECT: | APPLICATION NO: | ||||||||||
| 6819 Porto Fino Cir. #1 | |||||||||||||
| Ft. Myers, FL 33912 | APPLICATION DATE: | ||||||||||||
| PH: 239-454-7304; FX 239-454-7352 | PERIOD TO: | ||||||||||||
| FROM SUBCONTRACTOR: | |||||||||||||
| PROJECT NO: | |||||||||||||
| CONTRACT DATE: | |||||||||||||
| CONTRACTOR'S APPLICATION FOR PAYMENT | CERTIFICATE OF THE SUBCONTRACTOR | ||||||||||||
| Application is made for payment, as shown below, in connection with the Contract. | I hereby certify that the work performed and the materials supplied to date, as shown on the above | ||||||||||||
| Continuation Sheet, AIA Document G703, is attached. | Continuation Sheet, AIA Document G703, is attached represent the actual value of accomplishment under | ||||||||||||
| the terms of the contract (and all authorized changes thereto) between the undersigned and | |||||||||||||
| GCG Construction, Inc. relating to the above referenced project. I also certify that all laborers, | |||||||||||||
| materielmen, suppliers, contractors, and subcontractors used on or in connection with the performance | |||||||||||||
| 1. ORIGINAL CONTRACT SUM | $ | 0.00 | of this contract have been paid in full, except as noted on the reverse side. I further certify that I have | ||||||||||
| 2. Net change by Change Orders | $ | 0.00 | complied with all Federal, State, and Local tax laws, including Social Security laws and Unemployment | ||||||||||
| 3. CONTRACT SUM TO DATE (Line 1 ± 2) $ | $ | 0.00 | Compensation laws and Workmen's Compensation laws insofar as applicable to the performance of this | ||||||||||
| 4. TOTAL COMPLETED & STORED TO | $ | 0.00 | Contract. Furthermore, in consideration of the payments received, and upon receipt of the amount of this | ||||||||||
| DATE (Column G on G703) | request, the undersigned does hereby waive, release and relinquish any and all claims under any applicable | ||||||||||||
| 5. RETAINAGE: | surety bond, rights of lien upon the above premises and causes of action which the undersigned may now | ||||||||||||
| a. | 10% | % of Completed Work $ | 0.00 | have or hereafter acquire, including, but not limited to, those rights as contemplated by Chapters 255 | |||||||||
| (Column D + E on G703) | 0 | and 731, Florida Statutes, except for rights to the extent that payment is retained pursuant to written | |||||||||||
| agreement or payment to become due for work performed subsequent to the date hereof. | |||||||||||||
| b. | 10% | % of Stored Material $ | 0.00 | ||||||||||
| (Column F on G703) | 0.00 | ||||||||||||
| Total Retainage (Lines 5a + 5b or | SUBCONTRACTOR: | ||||||||||||
| Total in Column I of G703) | $ | 0.00 | |||||||||||
| 6. TOTAL EARNED LESS RETAINAGE | $ | 0.00 | |||||||||||
| (Line 4 Less Line 5 Total) | By: | Date: | |||||||||||
| 7. LESS PREVIOUS CERTIFICATES FOR | |||||||||||||
| PAYMENT (Line 6 from prior Certificate) | 0.00 | State of Florida: | |||||||||||
| 8. CURRENT PAYMENT DUE | $ | 0.00 | Subscribed and sworn to before me this ______________ day of _________________________20_____ | ||||||||||
| 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ | 0.00 | ||||||||||||
| (Line 3 less Line 6) | Notary Public: | ||||||||||||
| CHANGE ORDER SUMMARY | ADDITIONS | DEDUCTIONS | My Commission expires: | ||||||||||
| Current Month Change Orders | $0.00 | $0.00 | |||||||||||
| Previous Month Change Orders | $0.00 | $0.00 | |||||||||||
| TOTALS | $0.00 | $0.00 | |||||||||||
| NET CHANGES by Change Order | $0.00 | ||||||||||||
| AIA DOCUMENT G702 · APPLICATION AND CERTIFICATION FOR PAYMENT · 1992 EDITION · AIA · ©1992 | THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 | ||||||||||||
| Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee. | |||||||||||||
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