Okaloosa County BOCC — August 5, 2014 — Shalimar - OC Admin Building - D-B Services Pay Request - 7-30-2014 — reading text

“APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Modified) PAGE 1 OF 4 TO OWNER: Okaloosa County Board of County Commissioners 5489 Old Bethal Road Crestview, FL 32536 FROM CONTRACTOR: Lord & Son Construction, Inc. P. O. Box 1808 Ft. Walton Beach, FL 32549 CONTRACT FOR: CM Preconstruction PROJECT: APPLICATION NO.: 15 Shalimar Administrative Building DATE: 30-Jul-14 (New Phase 2) PERIOD TO: 31-Jul-14 1250 Eglin Parkway Shalimar, FL. 32579 CONTRACT NO.: C12-1995-FM ARCHITECT: DAG Architects 1223 Airport Road Destin, Florida 32541 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment as shown below, in connection with the Contract Continuation Sheet, AIA Document G703, is attached. Pen = 5. RETAINAGE: . ORIGINAL CONTRACT AMOUNT.............- . Net Change By Change Orders .............. . Contract Sum to Date (Line 1 + 2) . Total Completed & Stored to Date $904,667.00 $908,519.23 $1,813,186.23 $1,030,200.79 a. 0 % of Completed Work $0.00 {Columns D + E on G703) b. 0 % of Stored Material $0.00 (Column F on G703) 5. Total Retainage (Line 1 of G703) 6. Total Earned Less Retainage..............-.-- (Line 4 less Line 5 Total) 7. Less Previous Payments. 8. Current Payment Due . - $0.00 $1,030,200.79 $898,889.52 $131,311.27 The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and 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 Certificates for Payment were issued and pay- ments received from the Owner, and that currrent payment shown herein is now due. ven D. Lord ll, President Date: 30 July 2014 State of: Florida County of Okaloosa Subscribed and sworn to before JANIS A MORE me this 30th day of July 2014 COMMISSION # EE158329 by Leven D. Lord Il, personally known EXPIRES JAN 27 2016 LORID BONDED THROUGH RL INSURANCE COMPANY Notary Publi ete? La My Commission fe /- 27-L¢ ? CERTIFICATE FOR PAYMENT: In accordance with the Contract Documents, based on on-site observation and the data comprising this application, the Construction Coordinator and Owners Representative certify to the Owner that to the 9. Balance to Finish, Plus Retainage ............. $782,985.44 best of their knowledge, information and belief the Work has progressed as indicated, is in accordance {Line 3 less Line 6) with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $131,311.27 CHANGE ORDER SUMMARY ADDITIONS. DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Total changes approved in Application and on the Continuation Sheet that are changed to conform to the amount certified.) previous months by Owner $908,519.23 $0.00 Total approved this Month $0.00 $0.00 By: Date: NET CHANGES by Change Order $908,519.23 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 Owner or Contractor under this contract.