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<br /> Document G103 - 1992
<br /> Continuation Sheet
<br /> AlA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO:
<br /> containing Contractor's signed certification is attached. 3
<br /> APPLICATION DATE: of/os/11
<br /> In tabulations below,amounts are stated to the nearest dollar.
<br /> Use Column f on Contracts where variable rctainage for line items may apply. PERIOD TO: 01/05/11
<br /> I
<br /> ARCHITECT'S PROJECT NO:
<br /> A B C D I E P
<br /> G H 1
<br /> WORK COMPLETED
<br /> MATERIALS TOTAL
<br /> BALANCE
<br /> PRESENTLY COMPLETED RETAINAGE
<br /> SCHEDULED FROM PREVIOUS % TO
<br /> ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE
<br /> VALUE APPLICATION THIS PERIOD (G+C) FINISH
<br /> NO. (NOT IN TO DATE RATE)
<br /> (D+E) D OR E) (D+E+F) (C-G)
<br /> i
<br /> 1-' FEES & PERMITS 10,700 10,700 0 0 10,700 100 0 0
<br /> 2 DEMOLTION MATERIAL 8,000 8,000 0 0 8,000 100 0 0
<br /> 2-' DEMOLITION LABOR 38,000 38,000 0 0 38,000 1 100 0 0
<br /> 3-, ROOF INSULATION MATERIAL 155,400 155,400 0 0 155,400 100 0 0
<br /> 3-' ROOF INSULATION LABOR 78,200 78,200 0 0 i 78,200 100 0 0
<br /> 4-' ROOF MEMBRANE MATERIAL 66,700 66,700 0 0 66,700 100 0 0
<br /> 4-• ROOF MEMBRANE LABOR 53,000 53,000 0 0 53,000 100 0 0
<br /> 5-, SHEET METAL MATERIAL 16,800 16,800 0 0 16,800 100 0 0
<br /> 5-• SHEET METAL LABOR 53,200 53,200 0 0 53,200 100 0 0
<br /> 6-, MECHANICAL 68,000 68,000 0 0 68,000 100 0 0
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<br /> KAA.pnn cak.nnn I n n ;AA nee ton i _ 0 0_
<br /> CAUTION:You should sign an original AIA Contract Document,en which this text appears in RED.An original assures that changes will not be obscurer:
<br /> AIA Document 0703m—1992.Copyright @ 1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA"Document is protected by U.S.Copyrigh
<br /> Law and International Treaties.Unauthorized reproduction or distribution of this AIA"Document,or any portion of it.may result in severe civil and criminal penalties,and,A/.1 be rosecuted to the mvYirrum eeter,'.
<br /> possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AlA Contract Documents,a-mail The American Institute of Architects'legal
<br /> counsel,copyright@aia.org.
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