Document G702® – 1992

Application and Certificate for Payment

TO OWNER: PROJECT: APPLICATION NO: Distribution to:
PERIOD TO: OWNER □
CONTRACT FOR: ARCHITECT □
FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: CONTRACTOR □
PROJECT NOS: / / FIELD □
OTHER □
CONTRACTOR’S APPLICATION FOR PAYMENT 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
Application is made for payment, as shown below, in connection with the Contract.
with the Contract Documents, that all amounts have been paid by the Contractor for Work for
AIA Document G703®, Continuation Sheet, is attached. which previous Certificates for Payment were issued and payments received from the Owner, and
1. ORIGINAL CONTRACT SUM …………………………………………. $ 182,012.00 that current payment shown herein is now due.
2. NET CHANGE BY CHANGE ORDERS ………………………… $ CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 ± 2) ……………………….......... $ 182,012.00 By: Date:
4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) …… $ 33,200.00 State of:
5. RETAINAGE: County of:
a. 5 % of Completed Work Subscribed and sworn to before
(Columns D + E on G703) $ 1,660.00 me this day of
b. 5 % of Stored Material
(Column F on G703) $ 0.00 Notary Public:
My commission expires:
Total Retainage (Lines 5a + 5b, or Total in Column I of G703)…... $ 1,660.00
6. TOTAL EARNED LESS RETAINAGE ……………………………… $ 31,540.00 ARCHITECT’S CERTIFICATE FOR PAYMENT
(Line 4 minus Line 5 Total) In accordance with the Contract Documents, based on on-site observations and the data comprising
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT …………………. $ 0.0 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
(Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the
AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE ……………………………………… $ 31,640.00
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED ............................................................................. $
(Line 3 minus Line 6) $ 150,472.00 (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.)
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in previous months by Owner $ $ By: Date:
Total approved this month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTAL $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Change Order $

AIA Document G702® – 1992. Copyright © 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. The “American Institute of Architects,” “AIA,” the AIA Logo, “G702,” and
“AIA Contract Documents” are registered trademarks and may not be used without permission. To report copyright violations of AIA Contract Documents, e-mail copyright@aia.org.
 Document G703® – 1992
Continuation Sheet
AIA Document G702®, Application and Certificate for Payment, or G732™, Application and Certificate for APPLICATION NO:
Payment, Construction Manager as Adviser Edition, containing Contractor’s signed certification is attached.
APPLICATION DATE:
Use Column I on Contracts where variable retainage for line items may apply.
PERIOD TO:
ARCHITECT’S PROJECT NO:
A B C D E F G H I
WORK COMPLETED
MATERIALS TOTAL
BALANCE TO
ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED AND % RETAINAGE
DESCRIPTION OF WORK FINISH
NO. VALUE APPLICATION THIS PERIOD STORED STORED TO DATE (G ÷ C) (If variable rate)
(C – G)
(D + E) (Not in D or E) (D+E+F)

1 mobi/ins/bonds 11.200.00 0.0 11,200.00 0.0 11,200.00 100 0.0 560.00

2 Remove Curb 9,800.00 0.0 9,800.00 0.0 9,800.00 100 0.0 490.00
3 Curb 510LF 21,582.00 0.0 0.0
a.) labor 2,000.00
b.) mat 2,000.00
c.) pour 2,000.00 6,000.00 0.0 6,000.00 22 15,582.00 300.00
4 Storm 12" 10,100.00 0.0 4,200.00 0.0 4,200.00 40 5,900.00 210.00
5 Driveway/Flex 27,400.00 0.0 2,000.00 0.0 2,000.00 8 25,400.00 100.00
6 Remove asphalt 160.00 0.0 0.00 0.0 0.0 0 160.00 0.0
7 Remove Flatwork 680.00 0.0 0.0 0.0 0.0 0 680.00 0.0
8 18" Strip 7,008.00 0.0 0.0 0.0 0.0 0 7,008.00 0.0
9 Flexible Asphalt 3,000.00 0.0 0.0 0.0 0.0 0 3,000.00 0.0
10 S/w Flatwork 26,544.00 0.0 0.0 0.0 0.0 0 26,544.00 0.0
11 Trench former 31,400.00 0.0 0.0 0.0 0.0 0 31,400.00 0.0
12 Sidewalk Drain(s) 7,700.00 0.0 0.0 0.0 0.0 0 7,700.00 0.0
13 Hydromulch 6,500.00 0.0 0.0 0.0 0.0 0 6,500.00 0.0
14 V-swale 18,928.00 0.0 0.0 0.0 0 18,928.00 0.0

GRAND TOTAL 182,012.00 33,200.00 33,200.00 16 150,472.00 1,660.00

AIA Document G703® – 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. The “American Institute of Architects,” “AIA,” the AIA Logo, “G703,”
and “AIA Contract Documents” are registered trademarks and may not be used without permission. To report copyright violations of AIA Contract Documents, e-mail copyright@aia.org.