APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 2 PAGES

TO OWNER / G.C.: PROJECT: APPLICATION NO: 1 Distribution to:

PERIOD TO: OWNER
PROJECT NOS.: ARCHITECT
✘ GEN. CONTRACTOR

FROM SUBCONTRACTOR:
JAC- VIA ARCHITECT: CONTRACT DATE:
Isaacs Roofing Corp.
17225 S Dixie Hwy
Miami, FL 33157

CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best 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 complete
Continuation Sheet, AIA Document G703, is attached. in accordance with the Contract Documents, that all amounts have been paid by the Contra
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.
1. ORIGINAL CONTRACT SUM . . . . .. .. . . . . . . . . . . 0.00
2. Net change by Change Orders . .. .. . . . . . . . . . . 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 ± 2) . . . . . . . . . 0.00
4. TOTAL COMPLETED & STORED TO DATE . . . . . . . - By: ______________________________________________ Date: ______________________
(Column G on G703)
5. RETAINAGE: State of: FLORIDA County of: DADE
a. 10% of Completed Work - Subscribed and sworn to before day of ______________,###
(Column D + E on G703)
b. 10% of Stored Material 0.00 Notary Public:
(Column F on G703) My Commission expires:
Total Retainage (Lines 5a + 5b or
Total in Column I of G703) . . .. . . . . . . . . . . . - ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE ...................$ - In accordance with the Contract Documents, based on on-site observations and the data
(Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, the qua
PAYMENT (Line 6 from prior Certificate) . . . . . . 0.00 of the Work is in accordance with the Contract Documents, and the Contractor is entitled to
8. CURRENT PAYMENT DUE . . . . . . .. .. . . . . . . . . . . 0.00 payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE . . . 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED . . . . . . . . . . . $

CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differes from the amount applied. Initial all figures on
Total changes approved Application and on the Continuation Sheet that are changed to conform to the amount certifi
in previous months by Owner $0.00 $0.00 ARCHITECT:
Total approved this Month $0.00 $0.00 By: ______________________________________________ Date: ______________________
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
NET CHANGES by Change Orde $0.00 prejudice to any rights of the Owner or Contractor under this Contract.

AIA DOCUMENT G702 · APPLICATION AND CERTIFICATION FOR PAYMENT · 1992 EDITION · AIA · ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES

APPLICATION AND CERTIFICATE FOR PAYMENT containing Contractor's Application Number: 1

signed Certification, is attached. Use Column I on contracts where variable Application Date: 2/18/2015
retainage for the line items may apply Period To: 12/30/1899

ISAACS ROOFING CORP.

A B C D E F G H I J
Total
Work Completed Materials
Item Completed & % Balance To Finish Retainage
Description of Work Scheduled Value From Previous This Period Presently Stored
No. Stored To Date (G/C3) (C3-G) ((D+E)x10%)
Application (Not in D or E)
(D+E+F)

1 - - - - - 0% - -
2 - - - - - 0% - -
3 - - - - - 0% - -
4 - - - - - 0% - -
5 - - - - - 0% - -
6 - - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -
- - - - - 0% - -

Total Page 1 $ - $ - $ - $ - $ - 0% $ - $ -

2
Document G701
Change Order

PROJECT: CHANGE ORDER NUMBER:

OWNER

DATE:
ARCHITECT

PROJECT NO: ✘ GEN. CONTRACTOR

TO CONTRACTOR:
FIELD
CONTRACT DATE:
OTHER
CONTRACT FOR:

The contract is changed as follows:

(Include, where applicable, any undisputed amount attributable to previously executed Construction Change Directives)

The original Contract Amount was $ -

The net change by previously authorized Change Orders $ -
The revised Contract amount prior to this Change Order was $ -
The Contract will be altered by this Change Order in the amount of $ -
The new Contract amount including this Change Order will be $ -
The Contract Time will be altered by 0 days

The date of Substantial Completion as of the date of this Change Order is:

(Note: This Change Order does not include changes in the Contact Sum, Contract Time, or Guaranteed Maximum Price which have
been authorized by Construction Change Directive until the cost and time have been agreed upon by both the Owner / G.C. and
Subcontractor in which case a Change Order is executed to supersede the Construction Change Directive.)
NOT VALID UNTIL SIGNED BY THE SUBCONTRACTOR, AND OWNER / G.C.

Isaacs Roofing Corp.

ARCHITECT (Firm Name) SUBCONTRACTOR (Firm Name) OWNER / G.C. (Firm Name)

17225 S Dixie Hwy. Miami, FL 33157

ADDRESS ADDRESS ADDRESS

BY (Signature) BY (Signature) BY (Signature)

Typed Name Typed Name Typed Name

DATE DATE DATE

 OWNER

ARCHITECT

✘ GEN. CONTRACTOR

FIELD

OTHER

-
-
-
-
-

m Price which have

wner / G.C. and
Change Order # 01 $ -
Change Order # 02 $ -
Change Order # 03 $ -
Change Order # 04 $ -
Change Order # 05 $ -
Sub-Total = $ -