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CONTINU ON SHEET
<br />AIA Document G70 , APPLICATION AND CERTIFICATE FOR PAYMENT,
<br />containing Contractor's signed Certification, is attached.
<br />In tabulations below, amounts are stated to the nearest dollar.
<br />Use Column 1 on Contracts where variable retainage for line items may apply.
<br />AIA DOCUMOG703
<br />PAGE I
<br />APPLICATION NO.: 00007
<br />APPLICATION DATE:
<br />PERIOD TO.: 7/30/2004
<br />ARCHITECT'S PROJECT NO.: 23 -5290
<br />GES
<br />A
<br />.B
<br />C
<br />D E
<br />F
<br />G
<br />H
<br />1
<br />ITEM
<br />DESCRIPTION OF WORK
<br />SCHEDULED
<br />WORK COMPLETED
<br />MATERIALS
<br />TOTAL
<br />COMPLETED
<br />BALANCE
<br />AGE
<br />FROM PREVIOUS
<br />PRESENTLY
<br />NO.
<br />VALUE
<br />STORED
<br />AND STORED
<br />%
<br />TO
<br />;►F VARI
<br />F VARIABLE)
<br />APPLICATION
<br />(D + E)
<br />THIS PERIOD
<br />(NOT IN
<br />D OR E)
<br />TO DATE
<br />(D +E +F)
<br />(G -C)
<br />FINISH
<br />(C - G)
<br />RATE
<br />0000000001
<br />Mobilization
<br />$4,895.00
<br />$4,895.00
<br />$0.00
<br />$0.00
<br />$4,895.00
<br />100.000
<br />$0.00
<br />$0.00
<br />84,895.00 PER Is
<br />1.000
<br />1.000
<br />0
<br />0
<br />1.000
<br />0
<br />0
<br />0000000002
<br />Submersible Pumps
<br />$26,464.00
<br />$26,464.00
<br />$0.00
<br />$0.00
<br />$26,464.00
<br />100.000
<br />$0.00
<br />$0.00
<br />$13,232.00 PER ea
<br />2.000
<br />2.000
<br />0
<br />0
<br />2.000
<br />0
<br />0
<br />0000000003
<br />Control Panel
<br />$14,190.00
<br />$14,190.00
<br />$0.00
<br />$0.00
<br />$14,190.00
<br />100.000
<br />$0.00
<br />$0.00
<br />$14,190.00 PER Is
<br />1.000
<br />1.000
<br />0
<br />0
<br />1.000
<br />0
<br />0
<br />3000000004
<br />Lift Station cover, Hardware & drop pipe
<br />$2,266.00
<br />$2,266.00
<br />$0.00
<br />$0.00
<br />$2,266.00
<br />100.000
<br />$0.00
<br />$0.00
<br />$2,266.00 PER Is
<br />1.000
<br />1.000
<br />0
<br />0
<br />1.000
<br />0
<br />0
<br />)000000005
<br />10" DIP, CL 52 Station piping, valves & fitting
<br />$16,904.00
<br />$16,904.00
<br />$0.00
<br />$0.00
<br />$16,904.00
<br />100.000
<br />$0.00
<br />$0.00
<br />$16,904.00 PER Is
<br />1.000
<br />1.000
<br />0
<br />0
<br />1.000
<br />0
<br />0
<br />)00071006
<br />Painting
<br />$2,530.00
<br />$2,530.00
<br />$0.00
<br />$0.00
<br />$2,530.00
<br />100.000
<br />$0.00
<br />$0.00
<br />01
<br />$2,530.00 PER Is
<br />1.000
<br />1.000
<br />0
<br />0
<br />1.000
<br />0
<br />0
<br />r00C N 007
<br />t
<br />Select granular borrow (Iv)
<br />$0.00
<br />$0.00
<br />$0.00
<br />$0.00
<br />• $0.00
<br />0
<br />$0.00
<br />$0.00
<br />$22.00 PER cy
<br />0
<br />0
<br />0
<br />0
<br />0
<br />0
<br />0
<br />1000000008
<br />Agg base, CL 6
<br />$2,243.01
<br />$2,243.01
<br />$0.00
<br />$0.00
<br />$2,243.01
<br />100.000
<br />$0.00
<br />$0.00
<br />$33.00 PER tn
<br />67.970
<br />67.970
<br />0
<br />0
<br />67.970
<br />0
<br />0
<br />1000000009
<br />2" -2350 LV, Mix #4, wear course
<br />$3,646.50
<br />$3,646.50
<br />$0.00
<br />$0.00
<br />$3,646.50
<br />100.000
<br />$0.00
<br />$0.00
<br />$165.00 PER tn
<br />22.100
<br />22.100
<br />0
<br />0
<br />22.100
<br />0
<br />0
<br />000000010
<br />2" -2350 LV, Mix #3 non wear course
<br />$1,863.90
<br />$1,863.90
<br />$0.00
<br />$0.00
<br />$1,863.90
<br />100.000
<br />$0.00
<br />$0.00
<br />$114.00 PER tn
<br />16.350 .
<br />16.350
<br />0
<br />0
<br />16.350
<br />0
<br />0
<br />000000011
<br />Bituminous material for tack coat
<br />$0.00
<br />$0.00
<br />$0.00
<br />$0.00
<br />$0.00
<br />0
<br />$0.00
<br />$0.00
<br />$3.00 PER gi
<br />0
<br />0
<br />0
<br />0
<br />0
<br />0
<br />0
<br />:01
<br />Change Order 1
<br />$4,831.00
<br />$4,831.00
<br />$0.00
<br />$0.00
<br />$4,831.00
<br />100.000
<br />$0.00
<br />$0.00
<br />$79,833.41
<br />$79,833.41
<br />$0.00
<br />$0.00
<br />$79,833.41
<br />100.00%
<br />$0.00
<br />$0.00
<br />PO
<br />AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA® • 01992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
<br />AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
<br />"This document has been reproduced electronically with the permission of The American Institute or Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document without project - specific information is not permitted. Canted The American Institute of Architects
<br />to verify the current Version of this document and license stales."
<br />G703 -1992
<br />
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