APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702

APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PATO I OF 2 FACES TO CONTRACTOR: Lafayette Contractor% LLC 6100 Red Hook Quarto Sure A2.7 S? Thomas. US VI 00102 FROM: Newnan d Moll Concerto Contractors, Inc. 723 NOM St, Stile I Richmond. Maine 01357 COLD RAC.T 10R: Cast in plea coca= PROJECT: LSI Mechem:al LltelIsaa VIA CM: APPLICATION NO.: 5 PERIOD TO: 2LFeb-09 PROJECT NO.: CONTRACT DATE SUBCONTRACT NO.: OMEN/too To: OWNER ARCH/IF-CT X CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract Continuation Shed. AM Document G703 is ittaChed. I. 0 RIGLNAL CONTRACT SUNI... . 2. Net Change by Change Order.. 3. CONTRACT SUM TO DATE ( Line I - Line 2 ) 689,00000 689.000.00 4. TOTAL COMPLETED & STORED TO DATE............ S 548,592.40 (Cob= G on G703) s. RETAENAGE: a. jid% of Completed Work ( Column D E on G703) b. 10% of Stored Material ( Column Pon 0703 ) Total Retainage ( Line 5a + 51, or The und.csigned Contractor certifies tbst to the best of the Connuctor's laouiedge, info- forma ion and belief the Work anted by this Applica n far Payment has bete conapieted in accordance with the Cottram Dom:meets , that all anautits hare been paid by the Contra& for Work for v.-kith previous Certificates for Payment were Oared sod pay- ments received Dorn &Owner, and that the current payment shown bean is now that CON CTOR: B of County of: Subscribed and swam to before V il*-4-4 ne this day of fi 90 `eit 34 f5&O0 6. TOTAL EARNED LESS RETALNAGE ......................... S ( Line 4 less Line 5 Total ) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 From prior Certificate). 8. CURRENT PAYMENT DUE . . . . . . s 9. BALANCE TO FINISH, INCLUDING RETALNAGE esti (Line 3 Less Line 6 ) kg 5;11A•673 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes a td in previous months myna S - S - Total approved this S - S - TO rms s - S - NET CHANGES by clans order S - —striar4r 49 3;7 ;3. 14i 379,699.60 r 1‘4,e,3.5t, areetto, Notary Public: My Commission Expires: Da:a _Way CONSTRUCTION MANAGERS CERTIFICATE FOR PAYMENT In accordance with the Contest Docnnxids, bona on on-site carnations and the data core-Qrising thO application, & Architect cedilla to the Comm that to the best of the Are.iteefs keosiedge, information and belief the Work has propessed ss indicated, the quality of the Work is in accordance with the Conine% Documents, and the Ccetraetor is entitled to meant of the &NOUN:ICERTIFIED. AMOUNT CERTIFIED S #42.8) ( Attach omit:oration if amow,t aotilled differs from amount applied for. Initial all figura on this application and me the Confirmation Skeet that are changed to conform to the montt cartrfi CONSTR By. Dale: This C is not cegonablc. The A, ousrr CIMTFIED: payable only to the Contractor nerrad bends Issuance. Parma: and accePtance aPartzni am withc91 mejolic' to any rights of the Oster ar Coen-x:0r iScr this Cout--at. AlA Document C 702 G7U2.1992 EFTA00610437 Continuation Sheet AlA DOCUMENT G703 PAGE 2 OF 2 PAGES AlA Document G702, APPLICATION AND GERI LPICATE FOR PAYMaNIT. containing Conn-actor's signed Certification is attached. In tabulations below, =mats are stated to the nearer dollar. Use Color:all on Contracts where variable multiage for line item may apply. APPLICATION NO.: 5 APPLICATION DATE 25-Feb-09 PERIODTO 28-Feb-09 PROJECT NO.: A a C D e F 0 II I WORK COMT.STED MATERIALS TOTAL REM ECSCRIPTION OF w0ItE SCILEDULED IRON ntnvv;) us 2103 MUDD PRUENTLY CMIPLETED % DALAXLT ARTADIADE W. VALUE AP11.1CATKR: STORED ANT) STORED (0! E.) To fir VARIABLE ( D • II ) (NOTES' TO DAM FLNISII RATE) DorE) (D•E•F) ( C - 03 1 Mobilintion $ 20,000 S 20,000.00 S - S • $ :topoomo 100% S - 2 Reinforcing Steel S 125,000 S 106,250.00 S ' I8,750.00 S • 5 125,000.00 100% S - 3 Base slab - Labor S 40,000 S 40,000.00 S - S - 5 40,000.00 100% S - 4 Base slab - Matrrial S 3,000 $ 3,00900 $ - S - $ 3,000.00 100% S - 5 Walls C3' - Labor S 17,000 $ - S - S - S - 0% 5 17,000 6 Walls<8. - Mataiil S 2.000 $ - S - S S - 0% S 2,000 7 Walls>81- Labor $ 140.000 S 84,000.00 5 `35,000.00 $ - S 119,000.00 85% S 21,000 8 Walls>8' - Material S 14,000 S 8,400.00 S . 3,500.00 S S 11,900.00 85% S 2.100 9 Suspended Slab - Labor S 120,000 $ 24,000.00 $ 36,000.00 $ • S 60,000.00 SVY. S 60,000 11 Suspended Slab -Material S 19,440 S 3,888.00 S 5,832.00 S - S 9,720.00 50% S 9,720 12 Misc. Pads - Labor $ 8.000 S 8,000.00 S - S - S 8,000.00 100% S - 13 Misc. Pails • Materials S 1,000 S 1,000.00 $ - $ • $ 1,000.00 100% $ - 14 Equipment S 152,000 S 98,800.00 S 30,400.00 S - S 129,200.00 85% S 22,800 15 Gross Receipts S 27,560 S 16,811.60 S . 4,960.80 S • S 21,772.40 79% S 5,788 16 S - S - S • S S - 0% S - 17 S - S - S - S - S - 0% $ - 18 $ - S S - S - S - 0% $ - 19 5 - $ - $ - 5 - 5 - 0% S - 20 S S - S - $ - $ - 0% S - S 689,000.00 S 414,149.60 S 134,44220 $ S 548,592.40 S 140,408 $ . A1A DOCE'3117NT Div G703-1992 EFTA00610438