Application And Certificate For Payment Contractor printable pdf download

AIA DOCUMENT G702

APPLICATION AND CERTIFICATE FOR PAYMENT

PAGE ONE OF

PAGES

APPLICATION NO:

TO (OWNER):

PROJECT:

Distribution to:

OWNER

ARCHITECT

CONTRACTOR

PERIOD TO:

FROM (CONTRACTOR):

VIA (ARCHITECT):

ARCHITECT'S

PROJECT NO:

CONTRACT FOR:

CONTRACT DATE:

CONTRACTOR'S APPLICATION FOR PAYMENT

Application is made for Payment, as shown below, in connection with the Contract, Continuation Sheet,

CHANGE ORDER SUMMARY

AIA Document G703, is attached.

ADDITIONS

DEDUCTIONS

Change Orders approved in

1. ORIGINAL CONTRACT SUM

previous months by Owner

2. Net change by Change Orders

TOTAL

3. CONTRACT SUM TO DATE

Approved this Month

4. TOTAL COMPLETED & STORED TO DATE

Number

Date Approved

(Column G on G703)

5. RETAINAGE

a. _5____% of Completed Work

(Column D + E on G703)

% of Stored Material

(Column F on G703)

Total Retainage (Line 5A + 5b or

TOTALS

Total in Column I of G703)

6. TOTAL EARNED LESS RETAINAGE

Net change by Change Orders

The undersigned Contractor certifies that to the best of the Contractor's knowledge,

(Line 4 less Line 5 Total)

information and belief the Work covered by this Application for Payment has been completed

7. LESS PREVIOUS CERTIFICATES FOR

PAYMENT (Line 6 from prior Certificates)

in accordance with the Contract Documents, that all amounts have been paid by the Contractor

8. CURRENT PAYMENT DUE

for work which previous Certificates for Payment were issued and payments received from the

9. BALANCE TO FINISH, PLUS RETAINAGE

Owner, and that current payment shown herein is now due.

CONTRACTOR:

(Line 3 less Line 6)

State of:

County of:

day of

Subscribed and sworn to before me this

By:

Date:

Notary Public:

My Commission expires:

ARCHITECT'S CERTIFICATE FOR PAYMENT

AMOUNT CERTIFIED

(Attach explanation if amount certified differs from the amount applied for.)

In accordance with the Contract Documents, based on on-site observations and the data

comprising the above application, the Architect certifies to the Owner that to the best of the

ARCHITECT:

Architect's knowledge, information and belief the Work has progressed as indicated, the quality

of the Work is in accordance with the Contract Documents, and the Contractor is entitled to

By:

Date:

payment of the AMOUNT CERTIFIED.

This Certificate is not negotiable.

The AMOUNT CERTIFIED is payable only to the Contractor named

herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or

Contractor under this Contract.

Application And Certificate For Payment Contractor

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