APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 2 PAGES
TO (Owner): PROJECT: APPLICATION NO: Distribution to:
□ OWNER
PERIOD FROM:
□ ARCHITECT
TO:
□ CONTRACTOR
□
□
ATTENTION: CONTRACT FOR: ARCHITECT’S
PROJECT NO:
CONTRACT DATE:
CONTRACTOR’S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract.
Continuation Sheet, AIA Document G703, is attached
.
CHANGE ORDER SUMMARY
The present status of the account for this Contact is as follows:
ORIGINAL CONTRACT SUM …………………………………….. $__________________
Net change by Change Orders …………………………………… $__________________
CONTRACT SUM TO DATE ……………………………………… $__________________
_______________________________________________________________________________
TOTAL COMPLETED & STORED TO DATE …………………… $__________________
(Column G on G703)
RETAINAGE___________% ……………………………………… $__________________
or total in Column I on G703
TOTAL EARNED LESS RETAINAGE …………………………… $__________________
LESS PREVIOUS CERTIFICATES FOR PAYMENT ………….. $__________________
CURRENT PAYMENT DUE ………………………………………. $__________________
Change Orders approved
in previous months by Owner
TOTAL
ADDITIONS
DEDUCTIONS
Approved this Month
Number
Date Approved
TOTALS
Net change by Change Orders
The undersigned Contractor certifies that to the best of his knowledge, the information
and belief the Work covered by this Application for Payment has been completed in
accordance with the Contract Documents, that all amounts have been paid by him for
Work for which previous Certificates for Payment were issued and payments received
from the Owner, and that current payment should herein is now due.
CONTRACTOR:
By:_________________________________________________Date:__________
State of: County of:
Subscribed and sworn to before me this day of , _______
Notary Public:
My Commission expires:
ARCHITECT’S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on-site observations and the
data comprising the above application, the Architect Certifies to the Owner that the
Work is in accordance with the Contract documents; and that the Contractor is entitled
to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED …………………………………………….. $__________________
(Attach explanation if amount certified differs from the amount applied for.)
ARCHITECT:
BY:__________________________________________ 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 rights of
the Owner or Contractor under this Contract.
