AIA Document G703 1992

Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor ! !igne" certi#ication i! attac$e"% In ta&u'ation! &e'o(, amount! are !tate" to t$e neare!t "o''ar% )!e Co'umn I on Contract! ($ere *aria&'e retainage #or 'ine item! ma+ a,,'+% A ITEM NO% 0 C APPLICATION NO: 00APPLICATION DATE: PERIOD TO:

TM

DE2CRIPTION OF 3OR4

ARCHITECT'S PROJECT NO: -0%--./ D E F G 1 I 3OR4 COMPLETED TOTAL MATERIAL2 COMPLETED 0ALANCE TO RETAINAGE FROM 2C1ED)LED PRE2ENTLY 9 AND 2TORED FINI21 6IF 5ARIA0LE PRE5IO)2 5AL)E 6G : C7 T1I2 PERIOD 2TORED 6NOT RATE7 TO DATE 6C ; G7 APPLICATION IN D OR E7 6D8E8F7 6D 8 E7

0-0000 0<<000 0=2200 0=7200 -0-=2> 2>0/00 2>0/00 2>0/2> <-2<<<

Genera' Con"ition! Ca!t;in;,'ace concrete Concrete unit ma!onr+ Ca!t !tone ma!onr+ Out"oor me!!age "i!,'a+ E'ectrica' genera' re?uirement! 0a!ic materia'! an" met$o"! Groun"ing an" &on"ing Trenc$ing an" &ac@#i''ing GRAND TOTAL
A<>,=/B%B0 A0%00 A0%00 A0%00 A0%00 09 A<>,=/B%B0 A-,B22%.0

AIA Document G703 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. Copyright 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 will be prosecuted to the maximum extent possible under the law. This draft was produced by AIA software at 11:46:49 on 05/19/2008 under Order No.1000313740_1 which expires on 8/31/2008, and is not for resale. User Notes: (699066883)