CONTINUATION SHEET AIA DOCUMENT G703 Pace oF Pvcee AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 4 ‘Contractor’ sgnedcerifcton i tached. : APPLICATION DATE: |-Z|-O In tabulations below, amounts are stated to the nearest dll. Architectural Surface Designs PERIOD TO:f)-24 04 ‘Use Column Ion Contracts where variable retanage forline items may apply. «S49 ast 65th Street = ARCHITECT'S PROIECT NO: ©TOIbO Indianapolis, IN 46220 mn ee ERATE] — roar —q—} rane nora] wi VALUE | FROMPREVIOUS] THISPERIOD| PRESENTLY COMPLETED @+q) ‘TOFINISH | (IF VARIABLE) APPLICATION svoreD | ANDSToRED -0 | Rate @+e) (NOTIN, TODATE Boxe (preety ‘RE-FaBRicans 22767" MARBLE TOP> QTY #446414 CHANGE ono 3B toa | 7 24,0 6.10 3407394 43% | 4 0761 fh F0%249) 1G ,016:8 | | 29,064:70 | 4464.14 44, 4] Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document’s Authenticity 703-4902 ‘NAOCUENT G7e9CONTHATION SHEET FOR G72 1882 EDITON AND-© 1082 {THe muGREAN MOTTIUTE OF ARCATECTS, 1708 NEW YORK AVENUE Ki, WASHINGTON. 2mn62APPLICATI AND CERTIFICATION FOR PAYMENT. QOCUMENT G702 PAGE ONE OF Paces (0 OWNER SM. Wilson & Co, PROJECT: Sunrise-Carmel,IN APPLICATION NO: Distribution to: 2185 Hampton Avenue JOWNER St. Louls, MO 63139 |ARCHITECT periopto: |2-24-0 |CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: ‘Architectural Surface Designs 5149 East 65th Street provectNos: 070 (60 CONTRACTOR'S APPLICATION FOR PAYMENT ‘The undersigned Contractor certifies that to the bes of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract, information and belief the Work covered by this Application for Payment has been Continuation Sheet, ALA Document G703, is attached. completed in accordance with the Contract Documents, that al Soe contcmvat CONTRACT SUM Preyranter iat tg CONTRACTOR: CONTRACT SUM TO DATE (Line | +2) SOTAL COMPLETED & STORED TO 3 : e (TE (Colurn Gon 673) By. Mich ) Kage pus (“22-29 _ RETAINSOS ae BotCon et s_44, 042.47 sewothulirnes Semper acter ay” Tuan (Cofrin D +E on G703) ‘Subscribed beforemethis 22 day of fi neck Hh sx) ty Commesion Exes b,__ Seof Stored Materia s 2 Notny PblicDece I7scoc met [ease —_sauery 102011 ‘Carman oP) Ny Commie 9 36) ‘Total Retainage (Lines Sa+ Sb or tin Column Tof703) 54064 TOTAL EARNED LESS RETAINAGE 5 {nates Who Ome Docu tae once mrs ee ta (Line 4 Less Line $ Total) ‘comprising the application, the Architect certifies to the Owner that to the best of the _ L298 PREVIOUS CERTIFICATES FOR “vtec nevi noc ie Wot a propa erind, PAYMENT (Line 6 from prior Certificate) $.Z9,064:70 ——ssequalty ofthe Work is in xxordance with the Contact Docaments andthe Contactor CURRENT FAYMENT DUE ‘ iene spay of he AMOUNT CERTIFIED "BALANCE TO FINISH, INCLUDING RETAINAGE : Cine3 es Line) MOUNT CERTIFIED... s (4tach explanation amount certified cffes from the amount applied. Initial ol figures on this ‘ppaton and ote Contain St ha are changed conform wih amo ete) By: Date: ‘This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contactor aed herein. suns, pymet and ecceptance of payment ar wit rejudice to any rights ofthe Owner at Contractor under this Contact. i DOCUMENT GTE2-APPLATION AND GENTINGATIONFOR PAVWENT TORT EDTION AO’ © 12 "Tet AAGICAN WSTTUTEOF ARCHITECTS: TOS KEW YORK AVE, NW, WASHINGTON, 00 TOWSE Jeers may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee,