Loading...
Improvement Contracte_White Water Creek Bridge Restoration Phase 4CITY OF DUBUQUE, IOWA PUBLIC IMPROVEMENT CONTRACT HISTORIC WHITE WATER CREEK BRIDGE RESTORATION PROJECT PHASE 4 — WOOD DECKING THIS IMPROVEMENT CONTRACT ,(the Contract), made in triplicate, dated for reference purposes the ar c: day of (, ;y-; , 2012, between the City of Dubuque, Iowa, by its City Manager, through authority conferred upon the City Manager by its City Council (City) and Klauer Construction Company of the City of Dubuque, Iowa. For and in consideration of the mutual covenants herein contained, the parties hereto agree as follows: CONTRACTOR AGREES: 1. To furnish all material and equipment and to perform all labor necessary for the Historic White Water Creek Bridge Restoration Project, Phase 4 — Wood Decking. (the Project). The Project shall be made to the established grade and to the grades as shown on the profiles and cross sections on file in the City Engineer's office for this Project; in strict accordance with the requirements of the laws of the State of Iowa and ordinances of the City of Dubuque relating to public works, and in accordance with the Contract Document shall of which provisions and documents are each and all hereby referred to and made a part of this Contract just as much as if the detail statements thereof were repeated herein. 2. Contract Documents shall mean and include the following: All ordinances and resolutions heretofore adopted by the City Council having to do with the Project; the Notice to Bidders; the Contractor's Proposal; and the Plans, Specifications, and General Requirements as adopted by the City Council for the Project. 3. All materials used by the Contractor in the Project shall be the best of their several kinds and shall be put in place to the satisfaction of the City Manager. 4. The Contractor shall remove any materials rejected by the City Manager as defective or improper, or any of said work condemned as unsuitable or defective, and the same shall be replaced or done anew to the satisfaction of the City Manager at the cost and expense of the Contractor. 5. Five percent (5 %) of the Contract price shall be retained by the City for a period of thirty (30) days after final completion and acceptance of the Project by the City Council to pay any claim that may be filed within said time for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that time, as provided in Iowa Code Chapter 573. The City shall also retain additional sums to protect itself against any claim that has been filed against it for damages to persons or property arising through the prosecution of the work and such sums shall be held by the City until such claims have been settled, adjudicated or otherwise disposed of. 6. The Contractor has read and understands the specifications including General Requirements and has examined and understands the plans herein referred to and agrees not to plead misunderstanding or deception because of estimates of quantity, character, location or other conditions surrounding the same. 7. In addition to the guarantee provided for in the specifications, the Contractor shall also make good any other defect in any part of the Project due to improper construction notwithstanding the fact that said Project may have been accepted and fully paid for by the City, and the Contractor's bond shall be security therefore. 8. The Contractor shall fully complete the Project under this Contract shall be fully completed by November 16, 2012. 9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City from and against all claims, damages, losses and expenses, including but not limited to attorneys' fees, arising out of or resulting from performance of the Contract, provided that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction of property (other than the Project itself) including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of the Contractor, the Contractor's subcontractor, or anyone directly or indirectly employed by the Contractor or the Contractor's subcontractor or anyone for whose acts the Contractor or the Contractor's subcontractor may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. THE CITY AGREES: Upon the completion of the Contract, and the acceptance of the Project by the City Council, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, the amount determined for the total number of units completed at the unit prices stated in the Contractor's Proposal and less any liquidated damages provided for in the Contract Documents. The number of units stated in the plans and specifications is approximate only and the final payment shall be made by the work covered by the Contract. CONTRACT AMOUNT $ 15,852.00 FURTHER CONDITIONS The Contractor hereby represents and guarantees that it has not, nor has any other person for or in its behalf, directly or indirectly, entered into any arrangement or agreement with any other bidder, or with any public officer, whereby it has paid or is to pay any other bidder or public officer any sum of money or anything of value whatever in order to obtain this Contract; and it has not, nor has another person for or in its behalf directly or indirectly, entered into any agreement or arrangement with any other person, firm, corporation or association which tends to or does lessen or destroy free competition in the letting of this Contract and agrees that in case it hereafter be established that such representations or guarantees, or any of them are false, it will forfeit and pay not Tess than ten percent (10 %) of the Contract price but in no event be less than the amount specified as liquidated damages to the City. The surety on the bond furnished for this Contract, shall in addition to all other provisions, be obligated to the extent provided for by Iowa Code § 573.6, relating to this Contract, which provisions apply to said bond. The Contractor agrees, and its bond shall be surety therefore, that it will keep and maintain the Project in good repair for a period of two (2) year(s) after acceptance of the same by the City Council and its bond shall be security therefore. The City of Dubuque and the Contractor agree to comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act of 1970 (42 U.S.C. 1958 (H) et. seq.) and the Federal Water Pollution Act (33 U.S.C. 1368 et. seq.) as amended, Executive Order 11738, and Environmental Protection Agency regulations (40 CFR, Part 15). Contractor shall comply with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327 -330) and Department of Labor Regulations (29 CFR, Part 5). The City of Dubuque and the Contractor agree that Davis -Bacon Federal prevailing predetermined wage rates and related labor requirements and regulations will not apply to work under the contract. The City of Dubuque and the Contractor agree that equipment or products authorized to be purchased with federal funding awarded for this contract must be American -made to the maximum extent feasible, in accordance with Public Law 103- 121, Sections 606 (a) and (b). CITY OF DUBUQUE, IOWA By City Manager PRINCIPAL: By: Contractor Signature- ct„„11„„ata„,1 LOA-0 Title CERTIFICATE OF CITY CLERK This is to certify that a certified c py of the above Contract has been filed in my office on the /7 ffr-,7 day of 4T- , 2012. Keviry irnstahl, City Clerk PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS & SUBCONTRACTORS Submitting Department: ENGINEERING DEPARTMENT Please complete this form in its entirety and submit along with the executed Construction Contracts, Bonds and Certificate of Insurance. Upon receipt, the City Finance Department will work with the Iowa Department of Revenue to issue Sales Tax Exemption Certificates to the approved contractor(s) to allow for the purchase or inventory withdrawal of materials for the specified Construction Project free from State of Iowa Sales Tax. Construction Project Name: Historic White Water Creek Bridge Restoration Project Phase 4 - Wood Decking Project Description: The scope of the project includes providing all labor, materials, equipment and administration for the installation of new wood stringers and wood decking on the Historic White Water Creek Bridge which is located at the Bergfeld Pond recreational Area. Start Date (Bid letting date): October 2, 2012 Completion Date: November 16, 2012 1. General Prime Contractor: iq0l).k0...i (amply vUe_A, i Gy, 0_5,. Complete Address: (Include PO Box and Street Information) Contact Name: `ZQ OtA ).- . Complete Address: (Include PO Box and Street Information) 10 i S A-C Q A.,C..JL Federal I.D. Number: (or Include Social Security Number) City, State, Zip Code '...-LJ.,5-1,A._ ,tQ... ._- 1 - 5-D‘-C T . Telephone Number: `j (9 1- (_)D--4-1 v-1 Federal I.D. Number: (or Include Social Security Number) 1-( '- - I (--( c (D 3 Work Type to be Completed: Coeyu,,y oj bc)A'1 •- rLLc A---t -,-, 2. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: 3. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: ACCIDPRO CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 10/3/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Friedman Insurance, Inc. 880 Locust Street - Suite 200 P 0 Box 759 Dubuque IA 52004 -0759 NAME CT Joni Talsma, CISR PHONE INC No Ext): (563) 556 -0272 E -MAIL ADDRESS: FAX (563)556 -4425 (A/C, No): PRODUCER 00002298 CUSTOMER ID #: INSURED Klauer Development Corp. 1015 Century Circle Dubuque IA 52002 INSURER(S) AFFORDING COVERAGE INSURERA:United Fire & Casualty Company INSURER B : NAIC # 13021 INSURER C: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:11 -12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL X LIABILITY OCCUR X 60399146 12/31/201112/31 /2012 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) 200 000 $ r 1 CLAIMS -MADE MEDEXP(Anyoneperson) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY X PRCOT- PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 60399146 12/31/2011 12/31/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Underinsured motorist $ 500 , 000 Medical payments $ 2,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 60399146 12/31/2011 12/31/2012 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 0 $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 60399146 12/31/2011 12/31/2012 X WCY STATU- OT ER E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions & /or authorities and their board members, employees and volunteers are included as Additional Insureds as provided by endorsement CG7163.General Liability policy is primary and non - contributing. Governmental Immunities Endorsement applies. Waiver of Subrogation applicable to Workers Compensation. RE: White Water Creek CERTIFICATE HOLDER CANCELLATION 589 -0890 CITY OF DUBUQUE ATTN: KEN TEKIPPE 50 W 13TH STREET DUBUQUE, IA 52001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE T Friedman, CPCU /TJ ACORD 25 (2009/09) INS025 (200909) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 60399146 CG 71 63 04 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CITY OF DUBUQUE, IOWA ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The City of Dubuque, Iowa, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees, and volunteers, are included as Additional Insureds with respect to liability arising out of the Insured's work and /or services performed for the City of Dubuque, Iowa. This coverage shall be primary to the Additional Insureds, and not contributing with any other insurance or similar protection available to the Additional Insureds, whether other available coverage be primary, contributing or excess. CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT (For use when including the City as an Additional Insured) 1. Nonwaiver of Government Immunity. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time. 2. Claims Coverage. The insurance carrier further agrees that this policy of insurance shall cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time. 3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. Nothing contained in this endorsement shall prevent the carrier from asserting the defense of governmental immunity on behalf of the City of Dubuque, Iowa. 4. Non - Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa. CG 71 63 04 09 Page 1 of 2 *15022480* 1 ll 1 u11 111 lIl YI I11 CG 71 63 04 09 5. No Other Change in Policy. The insurance carrier and the City of Dubuque, Iowa agree that the above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy. CITY OF DUBUQUE, IOWA CANCELLATION AND MATERIAL CHANGES ENDORSEMENT Thirty (30) days Advance Written Notice of Cancellation, Non - Renewal, Reduction in insurance coverage and/or limits and ten (10) days written notice of non - payment of premium shall be sent to: City of Dubuque, 50 W. 13th St., Dubuque, Iowa 52001. This endorsement supersedes the standard cancellation statement on the Certificate of Insurance to which this endorsement is attached. Note: Endorsements above per `Urban Standard Specifications For Public Improvements', Addendum No. 2 effective July 24, 2001. CG 71 63 04 09 Page 2 of 2 NI/4 AIA Document G7O2TM -1992 Application and Certificate for Payment TO OWNER: 50W 13th Street PROJECT: Dubuque, IA 52001 FRO Ition Company 1015 Century Circle Dubuque, IA 52002 VIA ARCHITECT: ATCR BRID APPLICATION NO: 0 Page 1 of 2 PERIOD TO: 10/03/2012 CONTRACT FOR: CONTRACT DATE: 10/03/2012 PROJECT NOS: Distribution to: OWNER ❑ ARCHITECT ❑ CONTRACTOR FIELD OTHER CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. AIA Document G703TM, Continuation Sheet, is attached. 1. ORIGINAL CONTRACT SUM $ 2. NET CHANGE BY CHANGE ORDERS $ 3. CONTRACT SUM TO DATE (Line 1 ± 2) $ 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) $ 5. RETA�I Ij GE: a. % of Completed Work (cctidmns D +Eon G703) $ b. % of Stored Material (Column F on G703) $ 15,852.00 0.00 1 b,t3b2.0U 0.00 0.00 0.00 Total Retainage (Lines 5a + 5b, or Total in Column I of G703) $ 6. TOTAL EARNED LESS RETAINAGE $ (Line 4 minus Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 minus Line 6) 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 at .unts have been paid by the Contractor for Work for which previous Certificates for Payment �r' ere issued and payments received from the Owner, and that current payment i f' herein is . ue. Klonstr1 ti �'r/ . mpany CONTRACTOR: By: State of: County of; Subscribed me this Date: OCT 3,2012 rC Notary Public: "ow. 0.00 My conunission expires: [ l 31:3 0.00 0.00 0.00 15,852.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ 0.00 $ 0.00 Total approved this month $ 0 10 $ 0.00 TOTAL $ 0.00 $ 0.00 NET CHANGES by Change Order $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Architect certifies to the 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 with 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. CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G702TM — 1992. Copyright © 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. ,'l, TM == Document G702 -1992 Instructions Application and Certificate for Payment GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703TM, Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201TM, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. COMPLETING G702 After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702, Application and Certificate for Payment. The Contractor should sign G702, have it notarized, and submit it, together with G703, to the Architect. The Architect should review G702 and G703 and, if they are acceptable, complete the Architect's Certificate for Payment on G702. The Architect may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A201. The Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 and G703 should be forwarded to the Owner. MAKING PAYMENT The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA Document G702, Application and Certificate for Payment. The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. EXECUTING THE DOCUMENT Persons executing the document should indicate the capacity in which they are acting (i.e., president, secretary, partner, etc.) and the authority under which they are executing the document. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the tenor entity should be attached. AIA Document G7O2TM —1992. Copyright © 1953, 1963, 1965, 1971, 1978,1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. IA Document G703TM -1992 Continuation Sheet To: City of Dubuque 50 W 13th Street Dubuque, IA 52001 From Contractor: Klauer Construction Company 1015 Century Circle Dubuque, IA 52002 ...... __. . AIA Document G702TM -1992, Application and Certificate for Payment, or G732TM -2009, Application and Certificate for Payment, Construction Manager as Adviser Edition, containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. Use Column I on Contracts where variable retainage for line items may apply. Project: WHITE WATER BRIDGE APPLICATION NO: APPLICATION DATE: 0 PERIOD TO: 10/03/2012 ARCHITECT'S I Pl63.a NO: Page 2 of 2 A B C D E G H I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED FROM PREVIOUS APPLICATION (D +E) THIS PERIOD MATERIALS PRESENTLY STORED (Not in D or E) TOTAL COMPLETED AND STORED TO DATE (D +E +F) (G =C) BALANCE TO FINISH (C — G) RETAINAGE (If variable rate) 1 General Contruction 15,852.00 0.00 0.00 0.00 0.00 C 15,852.00 0.00 GRAND TOTAL CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. ... C CC AIA Document G703TTM —1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA° Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA° Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. 101210ACD44 ciATA Document G703 -1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G703TM, Continuation Sheet, is to be used in conjunction with AIA Document G702TM, Application and Certificate for Payment, or AIA Document G732TM, Application and Certificate for Payment, Construction Manager as Adviser Edition. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Documents A201TM, General Conditions of the Contract for Construction, and A232TM, General Conditions of the Contract for Construction, Construction Manager as Adviser Edition. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment, or G732TM, Application and Certificate for Payment, Construction Manager as Adviser Edition, whichever is applicable. Columns A, B and C. These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D. Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F. Eater here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed -This Period.) Column G. Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H. Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I. This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders. Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 or G732 form, whichever is applicable. Construction Change Directives. Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 of AIA Document A201 or Section 7.3 of AIA Document A232. The following is an example ofa Continuation Sheet for work in progress. Please note that dollar amounts shorn: below are for illustrative purposes only, and are not intended to reflect actual construction costs. A 8 C D 1 E F G H ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (Not NDarE) TOTAL COMPLETED AND STORED TO DATE (D +E +F) % (G +C) BALANCE TO FINISH (C - G) RETAINAGE (If variable rate) FROM PREVIOUS APPLICATION (D +E) THIS PERIOD 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000. 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS & MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 GRAND TOTAL 105,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703Ttn -1992 Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American nstitute of Architects. All rights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org.