K-6 - City's portion of Watermain - Hunt Club-Village Drive

AIA Type Document Application and Certification for Payment TO (OWNER): HIGH DEVELOPMENT HIGH DEVELOPMENT CORP 211 1ST AVE SE CEDAR RAPIDS, IA 52401 PROJECT: HUNT CLUB WATER MAIN APPLICATION NO: 1 PERIOD TO: 10/2/2024 FROM (CONTRACTOR): Dave Schmitt Construction Co 250 50th Ave SW Cedar Rapids, IA 52404 VIA (ARCHITECT): ARCHITECT'S PROJECT NO: 24903 DISTRIBUTION TO: - OWNER - ARCHITECT - CONTRACTOR CONTRACT FOR: City's responsibility is half the total amount → $17,738.19 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Type Document is attached. 1. ORIGINAL CONTRACT SUM ......................... $ 35,476.37 2. Net Change by Change Orders .................... $ 0.00 3. CONTRACT SUM TO DATE (Line 1 + 2) ............. $ 35,476.37 4. TOTAL COMPLETED AND STORED TO DATE .......... $ 35,476.37 5. RETAINAGE: a. _______00 % of Completed Work $ 0.00 b. _______00 % of Stored Material $ 0.00 Total retainage (Line 5a + 5b) .................. $ 0.00 6. TOTAL EARNED LESS RETAINAGE .................. $ 35,476.37 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) .................. $ 0.00 8. CURRENT PAYMENT DUE ............................ $ 35,476.37 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 0.00 #17,738.19 <table> <tr> <th>CHANGE ORDER SUMMARY</th> <th>ADDITIONS</th> <th>DEDUCTIONS</th> </tr> <tr> <td>Total changes approved in previous months by Owner</td> <td>0.00</td> <td>0.00</td> </tr> <tr> <td>Total approved this Month</td> <td>0.00</td> <td>0.00</td> </tr> <tr> <td>TOTALS</td> <td>0.00</td> <td>0.00</td> </tr> <tr> <td>NET CHANGES by Change Order</td> <td>0.00</td> <td></td> </tr> </table> The Undersigned Contractor certifies that to the best of the Contractor's 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. CONTRACTOR: Dave Schmitt Construction Co 250 50th Ave SW Cedar Rapids, IA 52404 By: [signature] Date: 10-2-2024 State of: County of: Subscribed and Sworn to before me this __________ Day of __________ 20__ Notary Public: My Commission Expires: ARCHITECT'S 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 owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ........................................ $ ______________________ (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: 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.