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<br />APPLICATION AND CERTIFICATe FOR PAYMENT. AlA Document 0702 <br /> <br />1 <br /> <br />TO (OWNER): <br /> <br />City of Sunny Isles Beach <br />18070 Collins Ave. 4th Floor <br />S~mny 191ee ee!ilch, PI ~;,i1eO <br /> <br />FROM (OONTRAOTOR): 17200 Oollins Avenue Ltd <br />1 ~4~ Tyler ~t <br />HolIYWooa. Florlt!ft ~~021 <br /> <br />CONTRACT FOR: <br /> <br />General Contraotfng <br /> <br />Application Is made for payment as shown below In connection <br />with th0 attochsd Contract Continuation ShS0t. <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />CHANGE ORDER SUMMARY <br /> <br />Change Ordere Approved In prevloue ADDITIONS DEDUCTIONS <br />months by Owners <br />Change Order No. 1 ill . <br />AFffi~OVEO THIS MtiliJTR u..".. <br />NUM~eR OR DATe <br />DESCRIPTION APPROVeD <br /> Totala . 0 <br />Net Change by Change Orders 0 <br /> <br />The undersIgned Contrac:tor certlnellthat to the best of the Contractor's <br />knowlelfge, Informflllon snd belief the Worll oovefelf by this Appllootllln <br />hall belln C:Qmpllltlld In Ilceordance with thl! Contract Doc:umentB. that all <br />llmounts hove been Pflllf by the Contrllolor for Worll for wIlloh prevlollll <br />Certlncallonll ware Issued and paymenlll received from the Owner, and <br />that current PBymentlfl nQW \lue. <br /> <br /> <br />By; <br />Jorg <br /> <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In acoDrr.1enoo with the CDntraot Documents, based on on.lll1e llbservallona snd the <br />data comprllllng the above application, the Architect cerllflsllto the Owner lhatto <br />the befit of the of Arohlleol'l! knowler;tgl!.lnforml!tlon Ilnd ball!!f, tM WQrll hill! <br />progMllsed alllndlcatlld and In accordance with the Conlreet Documents, and the <br />Ctmtroolor Ie entlllelf to payment of the <br /> <br />PROJECT: Town Center Park APPLICATION NO: <br /> <br />,)O~NO, <br /> <br />PI;RIO" TQ; <br /> <br />Q1/01/Qtl <br /> <br />CONTRAOT NO.: <br /> <br />ARCHITf;CiS <br />PRO,)!;CT NO; <br /> <br />1. ORIGINAl. CONTRACT SUM $ <br />2. Net Ch~nge by Change Ordere $ <br />3. CONTRACT SUM TO DATE (line 1 + 2) $ <br />4. TOTAL COMPLETED AND STORED TO DATE $ <br />(column I on oontlnuatlon sheet) <br />6. RETAINAGE <br />a. % of Oompleted W <br />b. % of Stored Material <br />Total Retalnage Held $ <br />6. TOTAL EARNED LESS RETAINAG~ $ <br />(line 4 less line 5) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ <br />(lIne 6 from previOUS Certlfioate) <br />8, OURRENT PAYMENT DUE $ <br />e. BALANCE TO FINISH. PLUS RETAINAGE <br />(line 3 leBB line 8) <br /> <br />39.000 <br /> <br />39,000 <br /> <br />39,000 <br /> <br />State of FLORIDA <br /> <br />County of BROWARD <br /> <br />Subscribed and sworn to before me this 31st day of January, 2006 <br /> <br />Notary Public: <br /> <br />My C9mmltltllon I;xplretl; <br /> <br />AMOUNT CERTIFIED: S ;U <br /> <br />ARCHIT~CT: ~~A1 <br /> <br />!;lATE: ~/A <br /> <br />Thill Certlflcste III not negollable. The AMOUNT CERTIFIED Is payable only to the Contractor nemed herein. ISBuance. payment and acceptance <br />of PlIyment fir!! without prejudice to lIny rights of the OWner Qr Contmotor IJml!lr thlfl Cgntract. <br />