Sheet 1: G702

	
	
	
	
	
	
	
	
	
	

		
APPLICATION AND CERTIFICATE FOR PAYMENT
		


		


		


		


		


		
AIA DOCUMENT G 702
		


		


		


		


		


		


		


		


		


	
	

		
To (Owner)
		


		


		


		


		


		
Project
		


		


		


		
Application Number  
		


		


		
 
		


		


	
	

		


		


		


		


		


		


		
 
		
 
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		
Application Date
		


		
 
		
[  ] OWNER
		


		


	
	

		


		


		


		


		


		


		
 
		
 
		


		


		


		


		
 
		
[  ] ARCHITECT
		


		


	
	

		
From 
		


		
The Krog Group
		


		


		


		


		
 
		


		


		
Period From:     
		


		
 
		
[  ] CONTRACTOR
		


		


	
	

		


		


		
4 Centre Drive
		


		


		


		
Job #
		


		


		


		
          To:
		


		
 
		


		


		


	
	

		


		


		
Orchard Park, New York  14127
		


		


		


		


		


		


		


		


		


		
 
		


		


		


	
	

		
Contract For:
		


		
 
		


		


		
 
		


		


		


		


		
CONTRACT DATE:   
		


		


		


		


		


	
	

		
Contractors Application for Payment
		


		


		


		


		


		


		
Application is made for Payment, as shown below, in connection with the
		


		


		


		


		


		


		


		


	
	

		
Change Order Summary
		


		


		


		


		


		


		
Contract.  Continuation Sheet, AIA Document G703, is attached.
		


		


		


		


		


		


		


		


	
	

		
Change Orders approved in
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
previous months by Owner
		


		


		
 
		
 -   
		


		


		
1. ORIGINAL CONTRACT AMOUNT
		


		


		


		


		


		
 -   
		


		


	
	

		
                 TOTAL
		


		


		
Additions
		
Deductions
		


		


		
2. Net Change by Change Orders
		


		


		


		


		
$
		
 -   
		


		


	
	

		
Approved this Month
		


		


		


		


		


		


		
3. CONTRACT SUM TO DATE
		


		


		


		


		


		
 -   
		


		


	
	

		


		


		


		


		


		


		


		
          (Line 1 + or -2)
		


		


		


		


		
   
		


		


		


	
	

		
Number
		
Date Approved
		


		


		


		


		


		
4. TOTAL COMPLETED & STORED TO DATE
		


		


		


		


		


		
 -   
		


		


	
	

		
 
		
 
		


		


		
 -   
		


		


		
           (Column G on G703)
		


		


		


		


		


		


		


		


	
	

		


		


		


		
 
		
 
		


		


		
5.  RETAINAGE (10% of Contract Completion)
		


		


		


		


		


		
 -   
		


		


	
	

		


		


		


		


		


		


		


		
           (Column I on G703)
		


		


		


		


		
  
		


		


		


	
	

		
               TOTALS
		


		


		


		
   
		


		


		
6. TOTAL EARNED LESS RETAINAGE
		


		


		


		


		


		
 -   
		


		


	
	

		
Net Change by change Orders
		


		


		


		


		
 -   
		


		
           (Line 4 less Line 5)
		


		


		


		


		


		


		


		


	
	

		
The undersigned Contractor certifies that to the best of the Contractor's
		


		


		


		


		


		


		
7. LESS PREVIOUS CERTIFICATES FOR  PAYMENT
		


		


		


		


		


		


		


		


	
	

		
knowledge, information and belief the Work covered by this application
		


		


		


		


		


		


		
            (Line 6 from prior Certificate)
		


		


		


		


		


		


		


		


	
	

		
for Payment has been completed in accordance with the Contract
		


		


		


		


		


		


		


		
 
		


		


		


		


		
 
		


		


	
	

		
Documents, that all amounts have been paid by the Contractor for Work
		


		


		


		


		


		


		
8. CURRENT PAYMENT DUE
		


		


		


		


		


		
 -   
		
   
		


	
	

		
for which previous Certificates for Payment were issued and payments 
		


		


		


		


		


		


		


		


		


		
 
		


		


		


		


		


	
	

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


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
9.  BALANCE TO FINISH, PLUS RETAINAGE
		


		


		


		


		


		
 -   
		


		


	
	

		
CONTRACTOR:  The Krog Group
		


		


		


		


		


		


		
         (Line 3 less Line 6)
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
By:________________________________________ Date:  
		


		


		


		


		


		


		
State of  New York        County of  Erie
		


		


		


		


		


		


		


		


	
	

		
Project Manager
		


		


		


		


		


		


		
Subscribed and sworn to before me this         day of                         , 20
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
Notary Public:
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
My commission expires:
		


		


		


		


		


		


		


		
 
	
	

		
ARCHITECT'S CERTIFICATE FOR PAYMENT
		


		


		


		


		


		


		
AMOUNT
		
CERTIFIED
		
 
		
 
		
$
		


		


		


		


	
	

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


		


		


		


		


		


		
Attach explanation is amount certified differs from the amount applied for.
		


		


		


		


		


		


		


		


	
	

		
and the data comprising the above application, the Architect certifies to the
		


		


		


		


		


		


		
ARCHITECT:
		


		


		


		


		


		


		


		


	
	

		
Owner that to the best of the Architect's knowledge, information and belief the
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Work has progressed as indicated, the quality of the Work is in accordance with 
		


		


		


		


		


		


		
By:
		


		


		
      Date:
		


		


		


		


		


	
	

		
the Contractor Documents, and the Contractor is entitled to payment for the
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
AMOUNT CERTIFIED.
		


		


		


		


		


		


		
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 the Owner or Contractor under the Contract.