APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF PAGES
TO (OWNER):
Driveline Baseball Enterprises LLC APPLICATION NO.: 1 Distribution to:
19612 70th Avenue S, X OWNER
___
Kent, WA 98032 PERIOD TO: 4/3/2020 ___ ARCHITECT
Mattila Painting, INC ___ CONTRACTOR
FROM (CONTRACTOR): 14911 Chain Lake Road, PMB 443 KA# ___ INSPECTOR
___
Monroe, WA 98272
CONTRACT FOR: Painting new Driveline Facility CONTRACT DATE: 3/19/2020
Application is made for Payment, as shown, in connection with the Contract. Continuation
CONTRACTOR’S APPLICATION FOR Sheet, AIA Document G702, is attached.
PAYMENT 1. ORIGINAL CONTRACT SUM ....................................... 35,200
$ ________________
CHANGE ORDER SUMMARY 2. Net change by Change Orders ..................................... $ ________________
Change Orders approved in previous ADDITIONS DEDUCTIONS 3. CONTRACT SUM TO DATE (Line 1+2)........................ 35,200
$ ________________
months by Owner 4. TOTAL COMPLETED & STORED TO DATE................ 35,200
$ ________________
TOTAL (Column G on G702)
Approved this Month 5. RETAINAGE:
Number Date Approved a. ____% of Completed Work $ ______________
(Column D+E)
b. ____% of Stored Material $ ______________
(Column F on G703)
Total Retainage (Line 5a + 5b or
Total in Column 1 of G702.......................................... 0
$ __________________
6. TOTAL EARNED LESS RETAINAGE............................ 35,200
$ __________________
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR
TOTALS PAYMENT (Line 6 from prior Certificate) .................... 0
$ __________________
8. CURRENT PAYMENT DUE........................................….. 35,200
$ __________________
9. BALANCE TO FINISH, PLUS RETAINAGE.................. 0
$ __________________
Net change by Change Orders
(Line 3 less Line 6)
The undersigned Contractor certifies that to the best of the Contractor’s knowledge, information CERTIFICATE FOR PAYMENT
and belief, the Work covered by this Application for payment has been completed in accordance In accordance with the Contract Documents, based on on-site observations and the data
with the Contract Documents, that all previous Certificates for Payment were issued and comprising the above application, the Architect/Inspector certifies to the Owner that to the best
payments received from the Owner, and that current payment shown herein is now due. of the his/her 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
CONTRACTOR: Mattila Painting to payment of the AMOUNT CERTIFIED.
Tyler Schofield 4/8/2020
Inspector: _________________________________ Date: ______________________
Tyler Schofield
By:________________________________________________ 4/8/2020
Date: ____________________
4/8/2020
Project Manager____________________________________ 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
State of: County of: rights of the Owner or Contractor under this Contract.
Please see Notary
Subscribed and sworn to before me this day of ,20
Stamp for this
Notary Public: information
My Commission expires: 35,200
AMOUNT CERTIFIED .......................................................... $ __________________________
(Attach explanation if amount certified differs from the amount applied for.)
Document Id: D5A4A4E0-7DAF-11EA-ADBE-4B4B8C316537
Page 1/3
OnlineNotary.net
CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1
Contractor’s signed Certification is attached. APPLICATION DATE: 4/8/2020
In Tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2020
Use Column 1 on Contracts where variable retainage for line items may apply.
WORK COMPLETED
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED FROM THIS PERIOD MATERIALS TOTAL % BALANCE TO RETAINAGE
NO. VALUE PREVIOUS PRESENTLY COMPLETED (G + C) FINISH
APPLICATION STORED AND STORED (C - G)
(D + E) (NOT IN D OR TO DATE
E) (D + E + F)
Painting new Driveline Facility 35,200 0 35,200 0 35,200 0 0
Document Id: D5A4A4E0-7DAF-11EA-ADBE-4B4B8C316537
Page 2/3
OnlineNotary.net
JURAT ATTACHMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed
the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that
document.
STATE OF ________________
Virginia }
COUNTY OF _______________________}
Arlington
The foregoing instrument was subscribed and sworn before me this date of
_____________,
04/13/2020 by _____________________________________________
Tyler Schofield
CHIRAG PATEL
ELECTRONIC NOTARY PUBLIC
COMMONWEALTH OF VIRGINIA
REGISTRATION # 7679556
COMMISSION EXP JUNE 30, 2020
Notary Stamp Placed at 2020/04/13 14:07:37 EST k0fur
(Notary Seal)
Notary’s Signature______________________________________________
7679556
Registration No.: _______________________________________________
June 30, 2020
Commission Expiration Date:___________
Document Id: D5A4A4E0-7DAF-11EA-ADBE-4B4B8C316537
Page 3/3
OnlineNotary.net
Powered by TCPDF (www.tcpdf.org)
