shelco, inc....1,293.54 l\iewline products inc 1,901.40 1,901.40 overhead door co of the high...

9
Shelco, Inc. Eblien School - Payables As of June 24, 2013 A B A+B Unpaid/ Held Accounts Total Due Subcontractor Retainage Payable Amt Vendors/Subs AOA Signs Inc Air-Vent Exteriors Inc Andrews & Hamilton Co Inc 3,690.00 3,690.00 Blue Ridge Glass 36,948.80 36,948.80 Carolina Interiors Flooring Outlet Inc 7,126.80 7,126.80 Concrete Connection Inc Cook & Boardman Inc 30,486.62 30,486.62 Custom Wood Products of Rural Hall Inc Doggett Concrete Inc Grindstaff Fence Co Inc 6,752.41 6,752.41 Hamilton Stephens Steele & Martin 1,145.91 1,145.91 Haynes Electric Construction Company KONE Inc Learning Environments Inc L & L Contracting Inc Manning Brothers Food Equipment Co Inc Morrow Brick Contractors, Inc. MT Waterproofing Co Inc 1,293.54 1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing Inc Perfect Polish Inc Rug Busters Inc Southern Energy Management Inc 5,655.00 5,655.00 Southern Flooring Inc 1,509.90 1,509.90 Southern Mechanical of the Carolinas Southend Painting Contractors Southern States Sprinkler Company LLC Spur Construction LLC Tate Steel Inc Butch Thompson & Company T.P. Howard's Plumbing Co. Inc 25,081.55 25,081.55 Warco Construction Inc. 122,192.52 1,145.91 123,338.43 R:\01 LEGAL\01 Suits and claims\0903002 Buncombe Co School\School Supt Issue\2013 06 25 Retain payable info 6/25/2013

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Page 1: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

Shelco Inc

Eblien School - Payables

As of June 24 2013

A B A+B

Unpaid Held Accounts Total Due

Subcontractor Retainage Payable Amt VendorsSubs

AOA Signs Inc

Air-Vent Exteriors Inc

Andrews amp Hamilton Co Inc 369000 369000

Blue Ridge Glass 3694880 3694880

Carolina Interiors Flooring Outlet Inc 712680 712680

Concrete Connection Inc

Cook amp Boardman Inc 3048662 3048662

Custom Wood Products of Rural Hall Inc

Doggett Concrete Inc

Grindstaff Fence Co Inc 675241 675241

Hamilton Stephens Steele amp Martin 114591 114591

Haynes Electric Construction Company

KONE Inc

Learning Environments Inc

L amp L Contracting Inc

Manning Brothers Food Equipment Co Inc

Morrow Brick Contractors Inc

MT Waterproofing Co Inc 129354 129354

lIewline Products Inc 190140 190140

Overhead Door Co of the High Country Inc 174650 174650

Patton Construction Group Inc

Peach State Roofing Inc

Perfect Polish Inc

Rug Busters Inc

Southern Energy Management Inc 565500 565500

Southern Flooring Inc 150990 150990

Southern Mechanical of the Carolinas

Southend Painting Contractors

Southern States Sprinkler Company LLC

Spur Construction LLC

Tate Steel Inc

Butch Thompson amp Company

TP Howards Plumbing Co Inc 2508155 2508155

Warco Construction Inc

12219252 114591 12333843

R01 LEGAL01 Suits and claims0903002 Buncombe Co SchoolSchool Supt Issue2013 06 25 Retain payable

info 6252013

------------------------------------------------

PAGE OF 8 PAGESAPPLICATION AND CERTIFICATE FOR PAYMENT TO OWNER Buncombe County Schools PROJECT West Buncombe Intermediate School AlA Document G702

175 Bingham Rd 59 Lees Creek Rd Asheville NC APPLICATION No26 Distribution to Asheville NC

28806 28806 PERIOD TO 25-JUN-13 D OWNER

PROJECT Nos 0903002 o ARCHITECTFROM CONTRACTOR Shelco Inc ARCHITECT Architectural Design Studio 30 Patewood Drive 90 Church Street INVOICE No090300229 o CONTRACTOR

Suite 151 Asheville NC o Greenville SC 29615 US 28801 CONTRACT DATE 08-DEC-09 o

CONTRACT FOR West Buncombe Intermediate School

CONTRACTORS APPLICATION FOR PAYMENT Application is made for payment as shown below in connection with the Contract Continuation sheet is attached

1 ORIGINAL CONTRACT SUM $ 2 Net change by change orders $

3 CONTRACT SUM TO DATE ( Line1 +- 2 ) $ 4 TOTAL COMPLETED amp STORED TO DATE $

(Column G on G703) 5 RETAINAGE

Total retainage Column I of G703) bullbullbullbullbullbullbullbullbullbullbull $

6 TOTAL EARNED LESS RET AINAGE $ (Line 4 less Line 5 Total)

7 LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) bullbullbullbullbullbullbullbullbullbullbull $

8 CURRENT PAYMENT DUE $1

9 BALANCE TO FINISH INCLUDING RETAINAGE (Line 3 less Line 6 ) $

(A)

1547935900

20120100

1568056000

1568056000

000

1568056000

1489107458

789485421

000

CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS I

Change Order approved in previous months by Owner

22954700 -2834600 I

APPROVED THIS MONTH

Number Date Approved I

(A) Excll ding any aI ~ounts that may be SUrr( 3R Owner Change (unding CCD dela) damages relatedclaims or SyStE m

resolved rder 14 and any

I

to the me chamfc a ~ I

I~ I

CURRENT TOTAL

Net Change by Change Orders

000 000

20120100 I

AlA DOCUMENT G702 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

The undersigned Contractor certifies that to the best of the Contractors knowledge information and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents that all amounts have been paid by the Contractor for Work for which previous Certificates for payment were issued and payments received from the Owner and that current payment shown herein is now due

~yO~ Date hal3 StaU no- C-amp GshyCounty of NecK( Y 6u(5 Subscribed and sworn to before

day of

EVA H HINKEL NOTARY PUBLIC

cklsnburg County North Carolina me this a 5 Notary Public My Commission ExplreaJII~ ZOl3

My Commission expires Ji 1 a ClJI3 l

ARCHITECTS CERTIFICATE FOR PAYMENT In accordance with the Contract Documents based on on-site observations and the data comprising the above application the Architect certifies to the Owner that to the best of the Architects knowledge information and belief the Work has progressed as indicated the quality of Work is in accordance with the Contract Documents and the Contractor is entitled to the payment of the AMOUNT CERTIFIED

AMOUNT CERTIFIED $

(Attach explanation If amount certified differs from the amount applied for Initial figures on this Application certified)

and on the Continuation Sheet that are changed to conform to the amount

ARCHITECT Architectural Design Studio

By 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 rights of the Owner or Contractor under this Contract

2

I

Shelco Inc

CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply PROJECT NO 0903002

A B D EC F HG

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO FROM

PREVIOUS VALUE

THIS APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED PER- BALANCE

TO DATE (G C) TO FINISH RETAINAGE

00

0101

0102

01 03

0104

01 05

0106

0107

0108

0201

0202

0203

0204

0205

0206

0207

0208

0301

0302

0303

0304

0305

0306

Original Contract

General Conditions

Final Cleanup

Discovery amp Change Allowance

Permanent Sign Allowance

PerformancePayment Bond

Builders Risk

Building Permit

Owners Protective Liability

SiteworkiSite Utilities

Survey amp Layout

Termite Treatment

SidewalksSitewalls

Dumpster Pad

Stained Sidewalks

FencesGates

Bike Loops

Continous Footing

Wall Concrete

Isolated Footings

Slab on Grade

Suspended Slab

Expansion Joint

851 70500

2650000

2000000

800000

8931200

27 60000

3150000

713900

199412000

1108400

1544900

280321 00

553900

951300

17154400

2554 00

76869300

29466200

2048400

43085500

5014700

2331 00

84596035

2650000

2000000

8000 00

89312 00

2760000

3150000

713900

199412000

1108400

1544900

28032100

553900

951300

171 54400

255400

76869300

294662 00

2048400

43085500

5014700

2331 00

574465

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

0 00

000

000

000

000

000

000

000

000

000

85170500

2650000

2000000

800000

8931200

2760000

31 50000

713900

199412000

1108400

1544900

28032100

553900

951300

17154400

255400

76869300

29466200

2048400

43085500

5014700

2331 00

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

1

I

I

3 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B

ITEM DESCRIPTION OF WORK NO

00 Original Contract

0401 Masonry

0501 Structural Steel

0502 Miscellaneous Steel

0503 Expansion Joints

0601 Wood Blocking

07 01 FireproofingSafing

07 02 Roof System

0703 Caulk amp Sealant

0704 WaterproofingDam p-Proof

0801 Doors Frames Hardware

0802 Fiberglass Sandwich Panel

0803 Overhead Door

0804 Access Doors

0806 WindowsStorefront

0901 DrywallFraming

0902 Drywall Acoustical

0903 Acoustical Wall Ceiling

0904 Ceramic

0905 VCTResilient

0906 Carpet

0907 Wood Flooring

0908 Painting

C

SCHEDULED VALUE

180000000

856 51400

1942500

4553 00

44311 00

330500

97195200

1200000

3500000

28277500

46632 00

1519000

269400

30017800

34500000

12925700

3831700

61 37500

7176600

4019300

988900

8562500

0 E

WORK COMPLETED (D+E)

FROM PREVIOUS

APPLICATION

180000000

85651400

1942500

455300

44 31100

330500

971 952 00

1200000

3500000

28277500

46 63200

1519000

269400

30017800

34500000

12925700

38 31700

61 37500

7176600

4019300

988900

8562500

THIS PERIOD

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F

MATERIAL PRESENTLY

STORED

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

G

TOTAL COMPLETED AND STORED

TO DATE

180000000

85651400

1942500

455300

4431100

330500

971 95200

1200000

3500000

28277500

46632 00

1519000

2694 00

30017800

34500000

12925700

3831700

6137500

7176600

4019300

988900

8562500

PER- (G C)

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

4 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26 Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E F G H I

ITEM NO

DESCRIPTION OF WORK SCHEDULED VALUE

WORK COMPLETED (D+E)

FROM PREVIOUS THIS

APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED

TO DATE PER- (G 1C)

BALANCE TO FINISH RETAINAGE

00

1001

1002

1003

1004

Original Contract

Toilet Partitions

Toilet Accessories

Aluminum Louvers

Flagpoles

391000

1686300

312300

213500

391000

1686300

312300

213500

000

000

000

000

000

000

000

000

391000

1686300

312300

213500

10000

10000

10000

10000

000

000

000

000

I 000 I

I

000 I

000 I

000 I

1005

1006

1007

1008

ChalkTackMarker Boards

Signage

Lockers

Fire Extinguishers

3800000

6979000

4070000

255600

3800000

6979000

40700 00

255600

000

000

000

000

000

000

000

000

38000 00

6979000

4070000

2556 00

10000

10000

10000

10000

000

000

000

000

000 I

I

000 I

000 I

000 I

1009

1101

Fire Dept Knox Box

Stage Curtains

41100

773600

411 00

773600

000

000

000

000

411 00

773600

10000

10000

000

000

000 I

000 I

1102 Projection Screen 695600 6956 00 000 000 6956 00 10000 000 000

11 03 Dock Equipment 124800 124800 000 000 124800 10000 000 000

1104 Food Service Equipment 307446 00 30744600 000 000 30744600 10000 000 000

1105 Ressidential Appliances 361500 361500 000 000 361500 10000 000 000

1106 Shop EquipmentPottery Klin 2423 00 242300 000 000 242300 10000 000 000

11 07 Athletic Equipment 34631 00 34631 00 000 000 34 631 00 10000 000 000

1201 Blinds 1002000 1002000 000 000 10020 00 10000 000 000

1202 Entrance Mats 3511 00 3511 00 000 000 3511 00 10000 000 000

1203 Manufactured Casework 35894500 35894500 000 000 35894500 10000 000 000

1204 Telescoping Bleachers 2020000 2020000 000 000 2020000 10000 000 000

1301 Trellis 2463700 2463700 000 000 2463700 10000 000 000

1401 Elevators 5850000 5850000 000 000 5850000 10000 000 000

5 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

00 Original Contract

1501 Sprinkler 107671 00 107671 00 000

1502 Plumbing 557901 00 55790100 000

1503 HVAC 181314100 1813141 00 000

1601 Electrical 168828700 168828700 000

000 000 000

Original Contract Total 1547935900 1547361435 5 74465

01 Change Order 1

6003 Unforseen Conditions removal of 132700 132700 000

dead animal from project sit

6004 Unforseen Condition- rock removal 149300 149300 000

6005 Unforseen Condition- stone 784400 784400 000

beddingon 36 pipe due to exsit

6006 Regulatory Review Comments 2037600 2037600 000

6008 Earthwork- Rock Removal 202 00 202 00 000

Change Order 1 Total 3124200 3124200 000

02 Change Order2

6010 Take Down existing playground 651900 651900 000

equipment

Change Order2 Total 651900 651900 000

03 Change Order 3

6012 Stie Changes - Owner chanage G-3 1430800 1430800 000

6013 Revised structural steel bracing 69600 69600 000

- - -shy -shy -shy - -shy -shy -shy -

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 107671 00 10000

000 557901 00 10000

000 1813141 00 10000

000 168828700 10000

000 000

--shy000 1547935900 10000

000 132700 10000

000 149300 10000

000 784400 10000

000 20 37600 10000

000 20200 10000

--shy000 3124200 10000

000 651900 10000

--shy000 651900 10000

000 1430800 10000

000 69600 10000

- - - - -

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

- -shy

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 2: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

------------------------------------------------

PAGE OF 8 PAGESAPPLICATION AND CERTIFICATE FOR PAYMENT TO OWNER Buncombe County Schools PROJECT West Buncombe Intermediate School AlA Document G702

175 Bingham Rd 59 Lees Creek Rd Asheville NC APPLICATION No26 Distribution to Asheville NC

28806 28806 PERIOD TO 25-JUN-13 D OWNER

PROJECT Nos 0903002 o ARCHITECTFROM CONTRACTOR Shelco Inc ARCHITECT Architectural Design Studio 30 Patewood Drive 90 Church Street INVOICE No090300229 o CONTRACTOR

Suite 151 Asheville NC o Greenville SC 29615 US 28801 CONTRACT DATE 08-DEC-09 o

CONTRACT FOR West Buncombe Intermediate School

CONTRACTORS APPLICATION FOR PAYMENT Application is made for payment as shown below in connection with the Contract Continuation sheet is attached

1 ORIGINAL CONTRACT SUM $ 2 Net change by change orders $

3 CONTRACT SUM TO DATE ( Line1 +- 2 ) $ 4 TOTAL COMPLETED amp STORED TO DATE $

(Column G on G703) 5 RETAINAGE

Total retainage Column I of G703) bullbullbullbullbullbullbullbullbullbullbull $

6 TOTAL EARNED LESS RET AINAGE $ (Line 4 less Line 5 Total)

7 LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) bullbullbullbullbullbullbullbullbullbullbull $

8 CURRENT PAYMENT DUE $1

9 BALANCE TO FINISH INCLUDING RETAINAGE (Line 3 less Line 6 ) $

(A)

1547935900

20120100

1568056000

1568056000

000

1568056000

1489107458

789485421

000

CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS I

Change Order approved in previous months by Owner

22954700 -2834600 I

APPROVED THIS MONTH

Number Date Approved I

(A) Excll ding any aI ~ounts that may be SUrr( 3R Owner Change (unding CCD dela) damages relatedclaims or SyStE m

resolved rder 14 and any

I

to the me chamfc a ~ I

I~ I

CURRENT TOTAL

Net Change by Change Orders

000 000

20120100 I

AlA DOCUMENT G702 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

The undersigned Contractor certifies that to the best of the Contractors knowledge information and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents that all amounts have been paid by the Contractor for Work for which previous Certificates for payment were issued and payments received from the Owner and that current payment shown herein is now due

~yO~ Date hal3 StaU no- C-amp GshyCounty of NecK( Y 6u(5 Subscribed and sworn to before

day of

EVA H HINKEL NOTARY PUBLIC

cklsnburg County North Carolina me this a 5 Notary Public My Commission ExplreaJII~ ZOl3

My Commission expires Ji 1 a ClJI3 l

ARCHITECTS CERTIFICATE FOR PAYMENT In accordance with the Contract Documents based on on-site observations and the data comprising the above application the Architect certifies to the Owner that to the best of the Architects knowledge information and belief the Work has progressed as indicated the quality of Work is in accordance with the Contract Documents and the Contractor is entitled to the payment of the AMOUNT CERTIFIED

AMOUNT CERTIFIED $

(Attach explanation If amount certified differs from the amount applied for Initial figures on this Application certified)

and on the Continuation Sheet that are changed to conform to the amount

ARCHITECT Architectural Design Studio

By 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 rights of the Owner or Contractor under this Contract

2

I

Shelco Inc

CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply PROJECT NO 0903002

A B D EC F HG

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO FROM

PREVIOUS VALUE

THIS APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED PER- BALANCE

TO DATE (G C) TO FINISH RETAINAGE

00

0101

0102

01 03

0104

01 05

0106

0107

0108

0201

0202

0203

0204

0205

0206

0207

0208

0301

0302

0303

0304

0305

0306

Original Contract

General Conditions

Final Cleanup

Discovery amp Change Allowance

Permanent Sign Allowance

PerformancePayment Bond

Builders Risk

Building Permit

Owners Protective Liability

SiteworkiSite Utilities

Survey amp Layout

Termite Treatment

SidewalksSitewalls

Dumpster Pad

Stained Sidewalks

FencesGates

Bike Loops

Continous Footing

Wall Concrete

Isolated Footings

Slab on Grade

Suspended Slab

Expansion Joint

851 70500

2650000

2000000

800000

8931200

27 60000

3150000

713900

199412000

1108400

1544900

280321 00

553900

951300

17154400

2554 00

76869300

29466200

2048400

43085500

5014700

2331 00

84596035

2650000

2000000

8000 00

89312 00

2760000

3150000

713900

199412000

1108400

1544900

28032100

553900

951300

171 54400

255400

76869300

294662 00

2048400

43085500

5014700

2331 00

574465

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

0 00

000

000

000

000

000

000

000

000

000

85170500

2650000

2000000

800000

8931200

2760000

31 50000

713900

199412000

1108400

1544900

28032100

553900

951300

17154400

255400

76869300

29466200

2048400

43085500

5014700

2331 00

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

1

I

I

3 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B

ITEM DESCRIPTION OF WORK NO

00 Original Contract

0401 Masonry

0501 Structural Steel

0502 Miscellaneous Steel

0503 Expansion Joints

0601 Wood Blocking

07 01 FireproofingSafing

07 02 Roof System

0703 Caulk amp Sealant

0704 WaterproofingDam p-Proof

0801 Doors Frames Hardware

0802 Fiberglass Sandwich Panel

0803 Overhead Door

0804 Access Doors

0806 WindowsStorefront

0901 DrywallFraming

0902 Drywall Acoustical

0903 Acoustical Wall Ceiling

0904 Ceramic

0905 VCTResilient

0906 Carpet

0907 Wood Flooring

0908 Painting

C

SCHEDULED VALUE

180000000

856 51400

1942500

4553 00

44311 00

330500

97195200

1200000

3500000

28277500

46632 00

1519000

269400

30017800

34500000

12925700

3831700

61 37500

7176600

4019300

988900

8562500

0 E

WORK COMPLETED (D+E)

FROM PREVIOUS

APPLICATION

180000000

85651400

1942500

455300

44 31100

330500

971 952 00

1200000

3500000

28277500

46 63200

1519000

269400

30017800

34500000

12925700

38 31700

61 37500

7176600

4019300

988900

8562500

THIS PERIOD

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F

MATERIAL PRESENTLY

STORED

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

G

TOTAL COMPLETED AND STORED

TO DATE

180000000

85651400

1942500

455300

4431100

330500

971 95200

1200000

3500000

28277500

46632 00

1519000

2694 00

30017800

34500000

12925700

3831700

6137500

7176600

4019300

988900

8562500

PER- (G C)

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

4 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26 Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E F G H I

ITEM NO

DESCRIPTION OF WORK SCHEDULED VALUE

WORK COMPLETED (D+E)

FROM PREVIOUS THIS

APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED

TO DATE PER- (G 1C)

BALANCE TO FINISH RETAINAGE

00

1001

1002

1003

1004

Original Contract

Toilet Partitions

Toilet Accessories

Aluminum Louvers

Flagpoles

391000

1686300

312300

213500

391000

1686300

312300

213500

000

000

000

000

000

000

000

000

391000

1686300

312300

213500

10000

10000

10000

10000

000

000

000

000

I 000 I

I

000 I

000 I

000 I

1005

1006

1007

1008

ChalkTackMarker Boards

Signage

Lockers

Fire Extinguishers

3800000

6979000

4070000

255600

3800000

6979000

40700 00

255600

000

000

000

000

000

000

000

000

38000 00

6979000

4070000

2556 00

10000

10000

10000

10000

000

000

000

000

000 I

I

000 I

000 I

000 I

1009

1101

Fire Dept Knox Box

Stage Curtains

41100

773600

411 00

773600

000

000

000

000

411 00

773600

10000

10000

000

000

000 I

000 I

1102 Projection Screen 695600 6956 00 000 000 6956 00 10000 000 000

11 03 Dock Equipment 124800 124800 000 000 124800 10000 000 000

1104 Food Service Equipment 307446 00 30744600 000 000 30744600 10000 000 000

1105 Ressidential Appliances 361500 361500 000 000 361500 10000 000 000

1106 Shop EquipmentPottery Klin 2423 00 242300 000 000 242300 10000 000 000

11 07 Athletic Equipment 34631 00 34631 00 000 000 34 631 00 10000 000 000

1201 Blinds 1002000 1002000 000 000 10020 00 10000 000 000

1202 Entrance Mats 3511 00 3511 00 000 000 3511 00 10000 000 000

1203 Manufactured Casework 35894500 35894500 000 000 35894500 10000 000 000

1204 Telescoping Bleachers 2020000 2020000 000 000 2020000 10000 000 000

1301 Trellis 2463700 2463700 000 000 2463700 10000 000 000

1401 Elevators 5850000 5850000 000 000 5850000 10000 000 000

5 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

00 Original Contract

1501 Sprinkler 107671 00 107671 00 000

1502 Plumbing 557901 00 55790100 000

1503 HVAC 181314100 1813141 00 000

1601 Electrical 168828700 168828700 000

000 000 000

Original Contract Total 1547935900 1547361435 5 74465

01 Change Order 1

6003 Unforseen Conditions removal of 132700 132700 000

dead animal from project sit

6004 Unforseen Condition- rock removal 149300 149300 000

6005 Unforseen Condition- stone 784400 784400 000

beddingon 36 pipe due to exsit

6006 Regulatory Review Comments 2037600 2037600 000

6008 Earthwork- Rock Removal 202 00 202 00 000

Change Order 1 Total 3124200 3124200 000

02 Change Order2

6010 Take Down existing playground 651900 651900 000

equipment

Change Order2 Total 651900 651900 000

03 Change Order 3

6012 Stie Changes - Owner chanage G-3 1430800 1430800 000

6013 Revised structural steel bracing 69600 69600 000

- - -shy -shy -shy - -shy -shy -shy -

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 107671 00 10000

000 557901 00 10000

000 1813141 00 10000

000 168828700 10000

000 000

--shy000 1547935900 10000

000 132700 10000

000 149300 10000

000 784400 10000

000 20 37600 10000

000 20200 10000

--shy000 3124200 10000

000 651900 10000

--shy000 651900 10000

000 1430800 10000

000 69600 10000

- - - - -

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

- -shy

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 3: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

2

I

Shelco Inc

CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply PROJECT NO 0903002

A B D EC F HG

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO FROM

PREVIOUS VALUE

THIS APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED PER- BALANCE

TO DATE (G C) TO FINISH RETAINAGE

00

0101

0102

01 03

0104

01 05

0106

0107

0108

0201

0202

0203

0204

0205

0206

0207

0208

0301

0302

0303

0304

0305

0306

Original Contract

General Conditions

Final Cleanup

Discovery amp Change Allowance

Permanent Sign Allowance

PerformancePayment Bond

Builders Risk

Building Permit

Owners Protective Liability

SiteworkiSite Utilities

Survey amp Layout

Termite Treatment

SidewalksSitewalls

Dumpster Pad

Stained Sidewalks

FencesGates

Bike Loops

Continous Footing

Wall Concrete

Isolated Footings

Slab on Grade

Suspended Slab

Expansion Joint

851 70500

2650000

2000000

800000

8931200

27 60000

3150000

713900

199412000

1108400

1544900

280321 00

553900

951300

17154400

2554 00

76869300

29466200

2048400

43085500

5014700

2331 00

84596035

2650000

2000000

8000 00

89312 00

2760000

3150000

713900

199412000

1108400

1544900

28032100

553900

951300

171 54400

255400

76869300

294662 00

2048400

43085500

5014700

2331 00

574465

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

0 00

000

000

000

000

000

000

000

000

000

85170500

2650000

2000000

800000

8931200

2760000

31 50000

713900

199412000

1108400

1544900

28032100

553900

951300

17154400

255400

76869300

29466200

2048400

43085500

5014700

2331 00

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

1

I

I

3 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B

ITEM DESCRIPTION OF WORK NO

00 Original Contract

0401 Masonry

0501 Structural Steel

0502 Miscellaneous Steel

0503 Expansion Joints

0601 Wood Blocking

07 01 FireproofingSafing

07 02 Roof System

0703 Caulk amp Sealant

0704 WaterproofingDam p-Proof

0801 Doors Frames Hardware

0802 Fiberglass Sandwich Panel

0803 Overhead Door

0804 Access Doors

0806 WindowsStorefront

0901 DrywallFraming

0902 Drywall Acoustical

0903 Acoustical Wall Ceiling

0904 Ceramic

0905 VCTResilient

0906 Carpet

0907 Wood Flooring

0908 Painting

C

SCHEDULED VALUE

180000000

856 51400

1942500

4553 00

44311 00

330500

97195200

1200000

3500000

28277500

46632 00

1519000

269400

30017800

34500000

12925700

3831700

61 37500

7176600

4019300

988900

8562500

0 E

WORK COMPLETED (D+E)

FROM PREVIOUS

APPLICATION

180000000

85651400

1942500

455300

44 31100

330500

971 952 00

1200000

3500000

28277500

46 63200

1519000

269400

30017800

34500000

12925700

38 31700

61 37500

7176600

4019300

988900

8562500

THIS PERIOD

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F

MATERIAL PRESENTLY

STORED

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

G

TOTAL COMPLETED AND STORED

TO DATE

180000000

85651400

1942500

455300

4431100

330500

971 95200

1200000

3500000

28277500

46632 00

1519000

2694 00

30017800

34500000

12925700

3831700

6137500

7176600

4019300

988900

8562500

PER- (G C)

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

4 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26 Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E F G H I

ITEM NO

DESCRIPTION OF WORK SCHEDULED VALUE

WORK COMPLETED (D+E)

FROM PREVIOUS THIS

APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED

TO DATE PER- (G 1C)

BALANCE TO FINISH RETAINAGE

00

1001

1002

1003

1004

Original Contract

Toilet Partitions

Toilet Accessories

Aluminum Louvers

Flagpoles

391000

1686300

312300

213500

391000

1686300

312300

213500

000

000

000

000

000

000

000

000

391000

1686300

312300

213500

10000

10000

10000

10000

000

000

000

000

I 000 I

I

000 I

000 I

000 I

1005

1006

1007

1008

ChalkTackMarker Boards

Signage

Lockers

Fire Extinguishers

3800000

6979000

4070000

255600

3800000

6979000

40700 00

255600

000

000

000

000

000

000

000

000

38000 00

6979000

4070000

2556 00

10000

10000

10000

10000

000

000

000

000

000 I

I

000 I

000 I

000 I

1009

1101

Fire Dept Knox Box

Stage Curtains

41100

773600

411 00

773600

000

000

000

000

411 00

773600

10000

10000

000

000

000 I

000 I

1102 Projection Screen 695600 6956 00 000 000 6956 00 10000 000 000

11 03 Dock Equipment 124800 124800 000 000 124800 10000 000 000

1104 Food Service Equipment 307446 00 30744600 000 000 30744600 10000 000 000

1105 Ressidential Appliances 361500 361500 000 000 361500 10000 000 000

1106 Shop EquipmentPottery Klin 2423 00 242300 000 000 242300 10000 000 000

11 07 Athletic Equipment 34631 00 34631 00 000 000 34 631 00 10000 000 000

1201 Blinds 1002000 1002000 000 000 10020 00 10000 000 000

1202 Entrance Mats 3511 00 3511 00 000 000 3511 00 10000 000 000

1203 Manufactured Casework 35894500 35894500 000 000 35894500 10000 000 000

1204 Telescoping Bleachers 2020000 2020000 000 000 2020000 10000 000 000

1301 Trellis 2463700 2463700 000 000 2463700 10000 000 000

1401 Elevators 5850000 5850000 000 000 5850000 10000 000 000

5 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

00 Original Contract

1501 Sprinkler 107671 00 107671 00 000

1502 Plumbing 557901 00 55790100 000

1503 HVAC 181314100 1813141 00 000

1601 Electrical 168828700 168828700 000

000 000 000

Original Contract Total 1547935900 1547361435 5 74465

01 Change Order 1

6003 Unforseen Conditions removal of 132700 132700 000

dead animal from project sit

6004 Unforseen Condition- rock removal 149300 149300 000

6005 Unforseen Condition- stone 784400 784400 000

beddingon 36 pipe due to exsit

6006 Regulatory Review Comments 2037600 2037600 000

6008 Earthwork- Rock Removal 202 00 202 00 000

Change Order 1 Total 3124200 3124200 000

02 Change Order2

6010 Take Down existing playground 651900 651900 000

equipment

Change Order2 Total 651900 651900 000

03 Change Order 3

6012 Stie Changes - Owner chanage G-3 1430800 1430800 000

6013 Revised structural steel bracing 69600 69600 000

- - -shy -shy -shy - -shy -shy -shy -

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 107671 00 10000

000 557901 00 10000

000 1813141 00 10000

000 168828700 10000

000 000

--shy000 1547935900 10000

000 132700 10000

000 149300 10000

000 784400 10000

000 20 37600 10000

000 20200 10000

--shy000 3124200 10000

000 651900 10000

--shy000 651900 10000

000 1430800 10000

000 69600 10000

- - - - -

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

- -shy

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 4: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

3 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B

ITEM DESCRIPTION OF WORK NO

00 Original Contract

0401 Masonry

0501 Structural Steel

0502 Miscellaneous Steel

0503 Expansion Joints

0601 Wood Blocking

07 01 FireproofingSafing

07 02 Roof System

0703 Caulk amp Sealant

0704 WaterproofingDam p-Proof

0801 Doors Frames Hardware

0802 Fiberglass Sandwich Panel

0803 Overhead Door

0804 Access Doors

0806 WindowsStorefront

0901 DrywallFraming

0902 Drywall Acoustical

0903 Acoustical Wall Ceiling

0904 Ceramic

0905 VCTResilient

0906 Carpet

0907 Wood Flooring

0908 Painting

C

SCHEDULED VALUE

180000000

856 51400

1942500

4553 00

44311 00

330500

97195200

1200000

3500000

28277500

46632 00

1519000

269400

30017800

34500000

12925700

3831700

61 37500

7176600

4019300

988900

8562500

0 E

WORK COMPLETED (D+E)

FROM PREVIOUS

APPLICATION

180000000

85651400

1942500

455300

44 31100

330500

971 952 00

1200000

3500000

28277500

46 63200

1519000

269400

30017800

34500000

12925700

38 31700

61 37500

7176600

4019300

988900

8562500

THIS PERIOD

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F

MATERIAL PRESENTLY

STORED

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

G

TOTAL COMPLETED AND STORED

TO DATE

180000000

85651400

1942500

455300

4431100

330500

971 95200

1200000

3500000

28277500

46632 00

1519000

2694 00

30017800

34500000

12925700

3831700

6137500

7176600

4019300

988900

8562500

PER- (G C)

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

4 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26 Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E F G H I

ITEM NO

DESCRIPTION OF WORK SCHEDULED VALUE

WORK COMPLETED (D+E)

FROM PREVIOUS THIS

APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED

TO DATE PER- (G 1C)

BALANCE TO FINISH RETAINAGE

00

1001

1002

1003

1004

Original Contract

Toilet Partitions

Toilet Accessories

Aluminum Louvers

Flagpoles

391000

1686300

312300

213500

391000

1686300

312300

213500

000

000

000

000

000

000

000

000

391000

1686300

312300

213500

10000

10000

10000

10000

000

000

000

000

I 000 I

I

000 I

000 I

000 I

1005

1006

1007

1008

ChalkTackMarker Boards

Signage

Lockers

Fire Extinguishers

3800000

6979000

4070000

255600

3800000

6979000

40700 00

255600

000

000

000

000

000

000

000

000

38000 00

6979000

4070000

2556 00

10000

10000

10000

10000

000

000

000

000

000 I

I

000 I

000 I

000 I

1009

1101

Fire Dept Knox Box

Stage Curtains

41100

773600

411 00

773600

000

000

000

000

411 00

773600

10000

10000

000

000

000 I

000 I

1102 Projection Screen 695600 6956 00 000 000 6956 00 10000 000 000

11 03 Dock Equipment 124800 124800 000 000 124800 10000 000 000

1104 Food Service Equipment 307446 00 30744600 000 000 30744600 10000 000 000

1105 Ressidential Appliances 361500 361500 000 000 361500 10000 000 000

1106 Shop EquipmentPottery Klin 2423 00 242300 000 000 242300 10000 000 000

11 07 Athletic Equipment 34631 00 34631 00 000 000 34 631 00 10000 000 000

1201 Blinds 1002000 1002000 000 000 10020 00 10000 000 000

1202 Entrance Mats 3511 00 3511 00 000 000 3511 00 10000 000 000

1203 Manufactured Casework 35894500 35894500 000 000 35894500 10000 000 000

1204 Telescoping Bleachers 2020000 2020000 000 000 2020000 10000 000 000

1301 Trellis 2463700 2463700 000 000 2463700 10000 000 000

1401 Elevators 5850000 5850000 000 000 5850000 10000 000 000

5 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

00 Original Contract

1501 Sprinkler 107671 00 107671 00 000

1502 Plumbing 557901 00 55790100 000

1503 HVAC 181314100 1813141 00 000

1601 Electrical 168828700 168828700 000

000 000 000

Original Contract Total 1547935900 1547361435 5 74465

01 Change Order 1

6003 Unforseen Conditions removal of 132700 132700 000

dead animal from project sit

6004 Unforseen Condition- rock removal 149300 149300 000

6005 Unforseen Condition- stone 784400 784400 000

beddingon 36 pipe due to exsit

6006 Regulatory Review Comments 2037600 2037600 000

6008 Earthwork- Rock Removal 202 00 202 00 000

Change Order 1 Total 3124200 3124200 000

02 Change Order2

6010 Take Down existing playground 651900 651900 000

equipment

Change Order2 Total 651900 651900 000

03 Change Order 3

6012 Stie Changes - Owner chanage G-3 1430800 1430800 000

6013 Revised structural steel bracing 69600 69600 000

- - -shy -shy -shy - -shy -shy -shy -

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 107671 00 10000

000 557901 00 10000

000 1813141 00 10000

000 168828700 10000

000 000

--shy000 1547935900 10000

000 132700 10000

000 149300 10000

000 784400 10000

000 20 37600 10000

000 20200 10000

--shy000 3124200 10000

000 651900 10000

--shy000 651900 10000

000 1430800 10000

000 69600 10000

- - - - -

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

- -shy

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 5: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

4 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26 Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E F G H I

ITEM NO

DESCRIPTION OF WORK SCHEDULED VALUE

WORK COMPLETED (D+E)

FROM PREVIOUS THIS

APPLICATION PERIOD

MATERIAL PRESENTLY

STORED

TOTAL COMPLETED AND STORED

TO DATE PER- (G 1C)

BALANCE TO FINISH RETAINAGE

00

1001

1002

1003

1004

Original Contract

Toilet Partitions

Toilet Accessories

Aluminum Louvers

Flagpoles

391000

1686300

312300

213500

391000

1686300

312300

213500

000

000

000

000

000

000

000

000

391000

1686300

312300

213500

10000

10000

10000

10000

000

000

000

000

I 000 I

I

000 I

000 I

000 I

1005

1006

1007

1008

ChalkTackMarker Boards

Signage

Lockers

Fire Extinguishers

3800000

6979000

4070000

255600

3800000

6979000

40700 00

255600

000

000

000

000

000

000

000

000

38000 00

6979000

4070000

2556 00

10000

10000

10000

10000

000

000

000

000

000 I

I

000 I

000 I

000 I

1009

1101

Fire Dept Knox Box

Stage Curtains

41100

773600

411 00

773600

000

000

000

000

411 00

773600

10000

10000

000

000

000 I

000 I

1102 Projection Screen 695600 6956 00 000 000 6956 00 10000 000 000

11 03 Dock Equipment 124800 124800 000 000 124800 10000 000 000

1104 Food Service Equipment 307446 00 30744600 000 000 30744600 10000 000 000

1105 Ressidential Appliances 361500 361500 000 000 361500 10000 000 000

1106 Shop EquipmentPottery Klin 2423 00 242300 000 000 242300 10000 000 000

11 07 Athletic Equipment 34631 00 34631 00 000 000 34 631 00 10000 000 000

1201 Blinds 1002000 1002000 000 000 10020 00 10000 000 000

1202 Entrance Mats 3511 00 3511 00 000 000 3511 00 10000 000 000

1203 Manufactured Casework 35894500 35894500 000 000 35894500 10000 000 000

1204 Telescoping Bleachers 2020000 2020000 000 000 2020000 10000 000 000

1301 Trellis 2463700 2463700 000 000 2463700 10000 000 000

1401 Elevators 5850000 5850000 000 000 5850000 10000 000 000

5 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

00 Original Contract

1501 Sprinkler 107671 00 107671 00 000

1502 Plumbing 557901 00 55790100 000

1503 HVAC 181314100 1813141 00 000

1601 Electrical 168828700 168828700 000

000 000 000

Original Contract Total 1547935900 1547361435 5 74465

01 Change Order 1

6003 Unforseen Conditions removal of 132700 132700 000

dead animal from project sit

6004 Unforseen Condition- rock removal 149300 149300 000

6005 Unforseen Condition- stone 784400 784400 000

beddingon 36 pipe due to exsit

6006 Regulatory Review Comments 2037600 2037600 000

6008 Earthwork- Rock Removal 202 00 202 00 000

Change Order 1 Total 3124200 3124200 000

02 Change Order2

6010 Take Down existing playground 651900 651900 000

equipment

Change Order2 Total 651900 651900 000

03 Change Order 3

6012 Stie Changes - Owner chanage G-3 1430800 1430800 000

6013 Revised structural steel bracing 69600 69600 000

- - -shy -shy -shy - -shy -shy -shy -

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 107671 00 10000

000 557901 00 10000

000 1813141 00 10000

000 168828700 10000

000 000

--shy000 1547935900 10000

000 132700 10000

000 149300 10000

000 784400 10000

000 20 37600 10000

000 20200 10000

--shy000 3124200 10000

000 651900 10000

--shy000 651900 10000

000 1430800 10000

000 69600 10000

- - - - -

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

- -shy

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 6: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

5 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

00 Original Contract

1501 Sprinkler 107671 00 107671 00 000

1502 Plumbing 557901 00 55790100 000

1503 HVAC 181314100 1813141 00 000

1601 Electrical 168828700 168828700 000

000 000 000

Original Contract Total 1547935900 1547361435 5 74465

01 Change Order 1

6003 Unforseen Conditions removal of 132700 132700 000

dead animal from project sit

6004 Unforseen Condition- rock removal 149300 149300 000

6005 Unforseen Condition- stone 784400 784400 000

beddingon 36 pipe due to exsit

6006 Regulatory Review Comments 2037600 2037600 000

6008 Earthwork- Rock Removal 202 00 202 00 000

Change Order 1 Total 3124200 3124200 000

02 Change Order2

6010 Take Down existing playground 651900 651900 000

equipment

Change Order2 Total 651900 651900 000

03 Change Order 3

6012 Stie Changes - Owner chanage G-3 1430800 1430800 000

6013 Revised structural steel bracing 69600 69600 000

- - -shy -shy -shy - -shy -shy -shy -

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 107671 00 10000

000 557901 00 10000

000 1813141 00 10000

000 168828700 10000

000 000

--shy000 1547935900 10000

000 132700 10000

000 149300 10000

000 784400 10000

000 20 37600 10000

000 20200 10000

--shy000 3124200 10000

000 651900 10000

--shy000 651900 10000

000 1430800 10000

000 69600 10000

- - - - -

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

- -shy

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 7: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

6 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NOIn tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICA TION PERIOD

03 Change Order 3

6014 Playground installation 11018000 11018000

6015 Change rigid insulationldelete -2012300 -2012300

sidewalk

Change Order 3 Total 10506100 10506100

04 Change Order 4

6016 Delete playground add form OCO3 -6 51900 -651900

Change Order 4 Total -651900 -651900

05 Change Order 5

6027 Adverse weather days 000 000

Change Order 5 Total 000 000

06 Change Order 6

6017 Delete quantity of concrete sidewalks -2158700 -21 58700

6018 Waterline Relocation 1064700 1064700

6019 Add asphalt paving and concrete pad 1655000 1655000

at dumpster

6020 Delete seeding at existing building -51500 -51500

6021 Change grade at parking area 327000 327000

existing elementary school

6022 Remove unsuitable soil at entrance 1056000 1056000

drive

6023 Add waterproofing at retaining wall 262700 262700

6024 Delete dashboard Allowance -10 50000 -1050000

6025 Change roofing from fully applied to -1926200 -19262 00

mechanially fastened

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1C)

000 11018000 10000

000 -2012300 10000

--shy000 10506100 10000

000 -651900 10000

--shy000 -651900 10000

000 000

--shy000 000

000 -2158700 10000

000 10647 00 10000

000 1655000 10000

000 -51500 10000

000 3270 00 10000

000 1056000 10000

000 262700 10000

000 -1050000 10000

000 -1926200 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 8: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

7 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

06 Change Order 6

6026 LEED Changes 13617 00 1361700

Change Order 6 Total 540700 540700

07 Change Order 7

6034 Hardware Change 564400 564400

6035 Food Service Equiment Change 62B00 62B00

6036 Change Door Frame at Electric Room 465 00 46500

6037 Extend Electrical Boxes for LEED 973 00 973 00

Changes

6038 Delete Allowacne for Sign -B56000 -B 56000

6039 Add Sanitary Drain at Dumpster 2B0300 2B0300

6040 Add Hot Water at Toilets 1936700 1936700

6041 Electrical for Media Equipment 735500 7355 00

6042 Deduct Electrical Outlets at front -61500 -61500

Entry

Change Order 7 Total 2806000 2806000

10 Change Order 10

6043 Relocate outdoor freezerlcppoler 155500 155500

units 40 North

6044 Make electrical changes to kitchen 319200 319200

equipment item 37 amp 45

6045 Make electrical change to kitchen 95400 95400

equipment item 8

6046 Extend freezerlcooler units 40 North 64200 64200

Change Order 10 Total 634300 634300

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G 1 C)

000 1361700 10000

--shy000 540700 10000

000 564400 10000

000 62B00 10000

000 46500 10000

000 97300 10000

000 -B 56000 10000

000 2B0300 10000

000 1936700 10000

000 735500 10000

000 -61500 10000

--shy000 2806000 10000

000 155500 10000

000 319200 10000

000 954 00 10000

000 64200 10000

--shy000 634300 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000 -shy -

I

I

I

I

I

I

I

I

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006

Page 9: Shelco, Inc....1,293.54 l\Iewline Products Inc 1,901.40 1,901.40 Overhead Door Co of the High Country Inc 1,746.50 1,746.50 Patton Construction Group Inc Peach State Roofing …

8 CONTINUATION SHEET AlA DOCUMENT G703 PAGE AlA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION NUMBER 26Contractors signed Certification is attached

APPLICATION DATE 06252013 INVOICE NO In tabulation below amounts are stated to the nearest cent

PERIOD TO 06252013 090300229Use Column I on Contracts where variable retainage for line items may apply

A B C 0 E

WORK COMPLETED (D+E) ITEM DESCRIPTION OF WORK SCHEDULED NO VALUE FROM

PREVIOUS THIS APPLICATION PERIOD

11 Change Order 11

6047 Site changes related to entry drive 837800 837800 000

6048 Credit to delete 111 sq yrds of heavy -355700 -355700 000

duty asphalt

Change Order 11 Total 482100 482100 000

12 Change Order 12

6049 Electrical changes to provide amp install 947000 947000 000

new data cabinets FB

Change Order 12 Total 947000 947000 000

13 Change Order 13

6051 Change EM Fixtures 1079700 1079700 000

Change Order 13 Total 1079700 1079700 000

F G

TOTAL MATERIAL COMPLETED

PRESENTLY AND STORED PER- STORED TO DATE (G C)

000 837800 10000

000 -355700 10000

--shy000 482100 10000

000 947000 10000

--shy000 947000 10000

000 1079700 10000

--shy000 1079700 10000

H

BALANCE TO FINISH

000

000

000

000

000

000

000

I

RETAINAGE

000

000

000

000

000

000

000

1568056000 1567481535 574465 000 1568056000 000 000 PROJECT TOTAL

AlA DOCUMENT G703 bull APPLICATION AND CERTIFICATE FOR PAYMENT THE AMERICAN INSTITUE OF ARCHITECTS 1735 NEW YORK AVENUE NW WASHINGTON DC 20006