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4AI Document 6732 - 2019

Application and Certificate for Payment, Construction Manager as Adviser Edition

TO OWNER: City School District of the PROJECT: New Rochelle 2023 Cap. Proj. Ph. APPLICATION NO: 001
City of 1
New Rochelle
515 North Avenue
New Rochelle, New York
10801

FROM VIA CONSTRUCTION Jacoobs Project Management Co. CONTRACT DATE:


CONTRACTOR: MANAGER: PROJECT NOS: 188 / 2301

CONTRACT FOR: VIA ARCHITECT: CSArch


CONTRACTOR'S APPLICATION FOR PAYMENT
The undersigned Contractor c

Application is made for payment, as shown below, in connection with the Contract. A1A information and belief the Work covered by
Document G703TM, Continuation Sheet, is attached. completed in accordance with the Contract Doc
the Contractor for Work for which previous

1. ORIGINAL CONTRACT SUM 0_.0_0 payments received from the Owner, and that current paym
....;..;."""

2. NET CHANGES IN THE WORK . 0.00 CONTR


3. CONTRACT SUM TO DATE (Line 1 ± 2) . 0.00 By:

4. TOTAL COMPLETED AND STORED TO DATE (Column G on G703) . ..0.;..;0.a.0;. State of:

5. RETAINAGE: County of:


Subscribed and sworn to before me this day of
a.0 % of Completed Work
Notary Public:
(Column D + Eon G703) 0.00 My Commission expires:
b. 0 % of Stored Material
(Column Fon G703) 0.00
Notary Public:
My Commission expires:

Total Retainage (Lines 5a + 5b or Total in Column I ofG703)......•....... o.oo CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 0 0 0 In accordance with the Contract Documents, based on eval
... .;..; .
. application, the Construction Manager and Architect certify to th
(Line 4 minus Line 5 Total)
0.00 that to the best of their knowledge, information and belief th
7. LESS PREVIOUS CERTIFICATES FOR
indicated, the quality of the Work is in accordance with the Cont
PAYMENT .........a......................

(Line 6from prior Certificate) Contractor is entitled to payment of the AMOUNT CER
8. CURRENT PAYMENT DUE , ----o-.o-c,ll AMOUNT CERTIFIED ,.
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation ifamount certi
Application and on the Continuation Sheet that are changed to conform with the amount certified.)
(Line 3 minus Line 6) 0.00 CONSTRUCTION MANAGER:
l$"
ARCHITECT: (NOTE: Ifmultiple Contractors a
Architect's Certification is not required.)
SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS Total changes
approved in previous months by Owner 0.00 0.00
kl}le"

Total approved this month including Construction 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is

Change Directives named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
TOTALS 0.00 0.00 the Owner or Contractor under this Contract.

NET CHAN GES IN THE WORK 0.00


AIA Document G732 --2019. Copyright 0 1992, 2009, and 2019. AII rights reserved. "The American Institute of Architects," "American Institute of Architects," "AIA," the AIA Logo, and
trademarks of The American Institute of Architects. This document was produced at 14:27:19 ET on 11/28/2023 under Order No.3104238697 which expires on 06/11/2024, is not for r
accordance with the AIA Contract Documents® Terms of Service. To report copyright violations, e-mail [email protected].
User Notes:
AI4 Document G703 -- 1992

A B C D E F
WORK COMPLETED '

FROM I
I
ITEM DESCRIPTION OF SCHEDULED
PREVIOUS
NO. WORK VALUE THIS PERIOD STORED STORED TO D
APPLICATION
(NOT IN D ORE) (D+E+F)
(D+E)

GRAND TOTAL

AIA Document G703 -- 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992. All rights reserved. "The American Institute of Architects," "American Ins
"AIA Contract Documents" are trademarks of The American Institute of Architects. This document was produced at 14:28:05 ET on 11/28/2023 under Order No.3104238
and may only be used in accordance with the AIA Contract Documents® Terms of Service. To report copyright violations, e-mail [email protected].
User Notes:
Continuation Sheet
AIA Document G7028, Application and Certification for Payment, or G7321M, APPLICATION NO: Applica
as Adviser Edition, APPLICATION DATE: containing Contractor's signed certification is attached.
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
G

MATERIALS TOTAL
PRESENTLY COMPLETED AND %
I
0 0 0.00] 0 0 0.00%
0 0 0.00] 0 0 0.00%
11

0 0 0.00] 0 0 0.00%
ii 0 0 0.00] 0 0 0.00%
0 0 0 0 0 0.00%
I 0 0 0 0 0 0.00%
I 0 0 0 0.00., 0 0.00%
0.00 -- 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
0 0 0 0.00] 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
- 0.00 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
0 0 0 0 0 0.00%
$0.00] $0.00 $0.00 $0.00 $0.00] 0.00%
Adviser Edition

APPLICATION NO: 001 Distribution to:

PERIOD TO:
OWNER: [ CONSTRUCTION MANAGER: [X
ARCHITECT: [

ONTRACT DATE: CONTRACTOR.: [X


ROJECT NOS: 188 / 2301 / FED: [

OTHER: 0

undersigned Contractor certifies that to the best of the Contractor's knowledge,

ief the Work covered by this Application for Payment has been
ance with the Contract Documents, that all amounts have been paid by
Work for which previous Certificates for Payment were issued and

wner, and that current payment shown herein is now due.

0.00 CONTRACTOR:
Date:

of:

ore me this day of


AYMENT
Documents, based on evaluations of the Work and the data comprising this
r and Architect certify to the Owner
, information and belief the Work has progressed as
n accordance with the Contract Documents, and the

ent of the AMOUNT CERTIFIED.


ED 0.00
h explanation ifamount certified differsfrom the amount applied. Initial allfigures on this

N MANAGER:
]te"
OTE: Ifmultiple Contractors are responsibleforperformingportions ofthe Project, the
ation is not required.)

The AMOUNT CERTIFIED is payable only to the Contractor

of
act.

chitects," "AIA," the AIA Logo, and "AIA Contract Documents" are
expires on 06/11/2024, is not for resale, is licensed for one-time use only. and may only be used in

(3B9ADA5D)
001

188-2301
H I

BALANCE TO RETAINAGE
FINISH (C-G) (IF VARIABLE
STORED TO DATE (G=C)
RATE)
D ORE) (D+E+F)

titute of Architects," "American Institute of Architects," "AIA," the AIA Logo, and
1 use only,
28/2023 under Order No.3104238697 which expires on 06/11/2024, is not for resale, is licensed for one-time
[email protected].
(3B9ADABD)
PPLICATION NO: Application and Certificate for Payment, Construction Manager
attached. PERIOD TO:
HITECT'S PROJECT NO:

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0.00 0.00
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
$0.00 $0.00

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