Aia Document G702 - 1992
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®
AIA
Document G702™ – 1992
Application and Certificate for Payment
TO OWNER:
PROJECT:
APPLICATION NO:
Distribution to:
PERIOD TO:
OWNER
:
CONTRACT FOR:
ARCHITECT
:
FROM
VIA
CONTRACT DATE:
CONTRACTOR
:
CONTRACTOR:
ARCHITECT:
PROJECT NOS:
FIELD
/
/
:
:
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
CONTRACTOR'S APPLICATION FOR PAYMENT
belief 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
Application is made for payment, as shown below, in connection with the Contract.
Certificates for Payment were issued and payments received from the Owner, and that current payment
Continuation Sheet, AIA Document G703, is attached.
shown herein is now due.
1. ORIGINAL CONTRACT SUM………………………………………………………
$0.00
2. NET CHANGE BY CHANGE ORDERS…………………………………………………………..
CONTRACTOR:
$0.00
3. CONTRACT SUM TO DATE (Line 1 ± 2) ………………………………………..
$0.00
By:
Date:
4. TOTAL COMPLETED & STORED TO DATE (Column G on G703)……………….
$0.00
5. RETAINAGE:
State of:
a.
0
% of Completed Work
County of:
(Column D + E on G703:
$0.00 )=
$0.00
Subscribed and sworn to before
b.
0
% of Stored Material
me this
day of
(Column F on G703:
$0.00 )=
$0.00
Notary Public:
Total Retainage (Lines 5a + 5b or Total in Column I of G703)…………………………..
$0.00
My Commission expires:
ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE…………………………………………….
$0.00
(Line 4 Less Line 5 Total)
In accordance with the Contract Documents, based on on-site observations and the data comprising this
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT………………………………..
application, the Architect certifies to the Owner that to the best of the Architect's knowledge,
$0.00
information and belief the Work has progressed as indicated, the quality of the Work is in accordance
(Line 6 from prior Certificate)
with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE………………………………………………………
$0.00
9. BALANCE TO FINISH, INCLUDING RETAINAGE
AMOUNT CERTIFIED…………………………………………………………………
(Line 3 less Line 6)
$0.00
$0.00
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this
Application and on the Continuation Sheet that are changed to conform with the amount certified.)
ARCHITECT:
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months by Owner
$0.00
$0.00
By:
Date:
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named
Total approved this Month
$0.00
$0.00
herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner
TOTALS
$0.00
$0.00
or Contractor under this Contract.
NET CHANGES by Change Order
$0.00
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