Aia Form G702 - Application And Certificate For Payment printable pdf download

APPLICATION AND CERTIFICATE FOR PAYMENT

AIA DOCUMENT G702

PAGE 1 OF

PAGES

TO (OWNER):

APPLICATION NO.:

Distribution to:

___ OWNER

PERIOD TO:

___ ARCHITECT

___ CONTRACTOR

FROM (CONTRACTOR):

KA#

___ INSPECTOR

___

CONTRACT FOR:

CONTRACT DATE:

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

CONTRACTOR’S APPLICATION FOR

Sheet, AIA Document G702, is attached.

PAYMENT

1. ORIGINAL CONTRACT SUM .......................................

$ ________________

CHANGE ORDER SUMMARY

2. Net change by Change Orders .....................................

$ ________________

3. CONTRACT SUM TO DATE (Line 1+2)........................

$ ________________

Change Orders approved in previous

ADDITIONS

DEDUCTIONS

months by Owner

4. TOTAL COMPLETED & STORED TO DATE................

$ ________________

TOTAL

(Column G on G702)

Approved this Month

5. RETAINAGE:

Number

Date Approved

a. ____% of Completed Work $ ______________

(Column D+E)

b. ____% of Stored Material

$ ______________

(Column F on G703)

Total Retainage (Line 5a + 5b or

Total in Column 1 of G702..........................................

$ __________________

6. TOTAL EARNED LESS RETAINAGE

............................

$ __________________

(Line 4 less Line 5 Total)

7. LESS PREVIOUS CERTIFICATES FOR

TOTALS

PAYMENT (Line 6 from prior Certificate) ....................

$ __________________

8. CURRENT PAYMENT DUE

........................................…..

$ __________________

9. BALANCE TO FINISH, PLUS RETAINAGE

..................

$ __________________

Net change by Change Orders

(Line 3 less Line 6)

CERTIFICATE FOR PAYMENT

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

and belief, the Work covered by this Application for payment has been completed in accordance

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

with the Contract Documents, that all previous Certificates for Payment were issued and

comprising the above application, the Architect/Inspector certifies to the Owner that to the best

payments received from the Owner, and that current payment shown herein is now due.

of the his/her 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

CONTRACTOR:

to payment of the AMOUNT CERTIFIED.

Inspector: _________________________________ Date: ______________________

By:________________________________________________ Date: ____________________

Project Manager____________________________________ Date: ____________________

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

State of:

County of:

rights of the Owner or Contractor under this Contract.

Subscribed and sworn to before me this

day of

,20

Notary Public:

My Commission expires:

AMOUNT CERTIFIED .......................................................... $ __________________________

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

Aia Form G702 - Application And Certificate For Payment

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