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0 <br /> 0 <br /> 0 <br /> C <br /> co <br /> APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE 6FTWO <br /> CD <br /> TO OWNER: PROJECT: Link Building-Additional APPLICATION NO: 1 Distribution to: CD <br /> m <br /> Orange County Application Date: 11/25/2018 =OWNER q <br /> P.O.Box 8181 =DESIGN-BUILDER IT <br /> Milsborough,NC 27278 PERIOD TO: 11/30/2018 w <br /> FROM DESIGN-BUILDER: � <br /> WxProofin mg LLC CD <br /> CD <br /> P.O.Box 8030 PROJECT NO: 19-036 CD <br /> Greensboro,NC 27419 a <br /> CONTRACT FOR:DESIGN AND CONSTRUCTION SERVICES CONTRACT DATE: I-Au -18 <br /> do <br /> DESIGN-BUILDER'S APPLICATION FOR PAYMENT W <br /> The undersigned Design-Builder certifies that to the best of the Design-Builder's knowledge, R <br /> Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been m <br /> Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by m <br /> the Design-Builder for Work for which previous Certificates for Payment were issued and -4 <br /> Cn <br /> payments received from the Owner,and that current payment shown herein is now due. <br /> O <br /> O <br /> 1- ORIGINAL CONTRACT SUM $ 12,320.00 m <br /> 2. Net change by Change Orders $ 0.00 DESIGN-Bill E u►►►►tt►uuxHhl,'0r� 00 <br /> t <br /> 3. CONTRACT SUM TO DATE{Line 1 2} $ 1 2,32q 00a�` �E CRlS •.,,� <br /> 4, TOTAL COMPLETED&STORED TO $ 12,320,00 <br /> DATE (Column G on G703) By: Date: ` 6 ( �P TA 1� <br /> 5. RETAINAGE <br /> a. 0.0% of Completed Work $ 0.00 State of 1[J0 LX� ��C�L��1�i�L County of:�.i,c <br /> {Column f+Eon ate} Subscribed and sworn to before me this to 4y of rIVbV +-c 3�� 'zz CK ` <br /> &. 0.0°/a of Stored Material $ p.00 Notary Publi � ►°lJgLtiC � <br /> {Column F on G703) My Commissia expires: �] [ Z ,yn'� _�0 <br /> Total Retainage{Lines 5a+5b or <br /> Total in Column I ofG703 <br /> } $ 0.00 ARCHITECTS CERTIFICATE FOR PAYMENT +n1,, 0VN''��� <br /> 6- TOTAL EARNED LESS RETAINAGE $ 12,320.0D In accordance with the Contract Documents,based on on-site observations and the data <br /> (Line 4 Less Line 5 Total) comprising the application,the Architect certifies that to the best of the <br /> T LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, <br /> PAYMENT{Line 6 from prior Certificate} $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Design-Builder <br /> 8. CURRENT PAYMENT DUE $ 12,320-00 is entitled to payment of the AMOUNT CERTIFIED- <br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE S 0-00 <br /> {Line 3 less Line 6} AMOUNT CERTIFIED.-..._-....$ <br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Allach explanation rfaino4w certified dli fersfr om the amount applied.Initial all figures on this <br /> Total changes approved Application and onthe Continuation Sheet that are charged to conform with the amount cer•ifred) <br /> in previous months by Owner $0-00 $0.00 ARCHITECT: <br /> Total approved this Month $0.00 $0.00 By: Date: <br /> TOTALS $0.00 $0.001 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br /> Design-Builder named herein.Issuance,payment and acceptance of payment are without <br /> NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Design-Builder under this Contract. <br /> AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT 1W2 EDITION A1Ae•0 t992 THE AMERICAN INSTITUTE OF ARCHnECTS,1785 NEW YORK AVE..N.W.,WASHINGTON.OC 2006.5292 <br /> Users may obtain validation of this document by requesting a Completed AIA Document D401-Certification of Document's Authenticity from the Licensee. <br />